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WILTON FAMILY YMCA MEMBERSHIP AGREEMENT
If my membership dues are paid through Credit Card draft or Electronic Funds Transfer, I understand this is a continuous membership plan. This membership will remain in effect for as long as I maintain current payment. It is my complete understanding that if I wish to terminate my continuous membership plan in any way, I must give the Riverbrook Regional YMCA 30 days written notice and receive confirmation from the Y stating my membership has been terminated.
I understand it is my responsibility to notify the Riverbrook Regional YMCA of any change in address, bank account information (if utilizing bank draft for payment of dues) or credit card information /expiration date (if utilizing credit card for payment of dues).
I understand that the Riverbrook Regional YMCA assumes no responsibility for injuries or illnesses which I may sustain as a result of my physical condition or resulting from my participation in any athletic activities, sports program, the use of any equipment, exercise, or other activities. I expressly acknowledge on behalf of myself and my heirs that I assume the risk for any and all injuries and illnesses which may result from my participation in these activities. I hereby release and discharge the Riverbrook Regional YMCA, its agents, servants and employees from any and all claims for injury, illness, death, loss or damage which I may suffer as a result of my participation in these activities.
In an emergency, I authorize the Riverbrook Regional YMCA to administer first aid by trained staff and to obtain emergency medical treatment for any person listed on this membership. I understand the Wilton Ambulance Corp will be contacted for transportation to Norwalk Hospital Emergency Room. I accept responsibility for all fees incurred in the care and transportation.
I understand that the Riverbrook Regional YMCA is not responsible for personal property lost or stolen while members and/or program participants are using the Y facilities or on Y premises.
I give my permission to the Riverbrook Regional YMCA to use, without limitation or obligation, photographs, film footage, or tape recordings which may include my image or voice for promoting or interpreting Y programs.
I acknowledge this Agreement and accept the Membership Policies set forth above, in the Program Brochure and on the website and, being in sympathy with the goals and purposes of the Riverbrook Regional YMCA, hereby apply for membership.
WILTON FAMILY YMCA
404 Danbury Road Wilton, CT 06897
http://www.wiltonymca.org * 203-762-8384