Summit Area YMCA Membership Waiver

Summit Area YMCA Membership Waiver

In an effort to keep our members and facilities safe, and in order to use the facilities, all members and guests 18+ years and a parent/guardian for minor participants under the age of 18 are required to agree and sign our Waiver and Release of Liability, Billing Terms & Conditions and Member's Code of Conduct.
MEMBER INFORMATION
ATTENTION: Users must be 18 years or older to complete this form. For members under 18, the primary information provided in this section (name, address, date of birth, and contact details) must belong to a parent or legal guardian.
Membership Status*

MemberGuest
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Phone Number*
ex. 555-555-5555
Email Address*
example@example.com
Add a Dependent (Ages 17 and under)
EMERGENCY CONTACT INFORMATION
ATTENTION: Emergency contacts must be 18 years or older and someone other than yourself.
Name*

First NameLast Name
Phone Number*
ex. 555-555-5555
Relationship to Primary Member*
Home Branch*

Berkeley Heights YMCABerkeley Heights Community Pool at the YMCASpringfield Community PoolSummit YMCAThe Learning Circle YMCA
Waiver and Release of Liability

Additional Waivers