Membership Terms and Program Participation Waiver and Agreement

Waiver for Program Participation (Required)
I understand that I am participating in Y activities at my own risk and will not hold the Lakeland Hills YMCA liable and that the American Medical Association recommends that a person taking part in any strenuous physical activities consult their physician prior to participation.

I hereby assign and grant to the Lakeland Hills Family YMCA (and/or its clients) all rights of every kind and character whatsoever to copyright and/or use, reuse, publish photographs or the name and/or likeness of me in which I may be included, in whole or in part, of composite or reproduction thereof in color or otherwise, still or moving, without restriction as to changes or alterations, for any commercial print or advertising purpose whatsoever, with no time restriction.

1. I understand the YMCA is not responsible for lost or stolen property.

2. I have received the New Member Guide and understand that I have two days from the date on this application to request a refund of my membership fees if I do not agree with any of the policies or procedures stated in the guide.

3. I understand that membership and program fees are not refundable other than the reason stated above.

4. I understand that membership is not transferrable to another person.

5. I understand that I am participating in Y activities at my own risk and will not hold the YMCAli able and that the American Medical Association recommends that a person taking part in any strenuous physical activities consult their physician prior to participation.

6. The YMCA conducts regular sex offender screenings on all members, participants, and guests. If a sex offender match occurs, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access.

7. By participating in the YMCA Nationwide Membership Program, I agree to release the National council of Young Men's Christian Associations of the united States of America, and its independent and autonomous member associations in the united States and Puerto Rico, from claims of negligence for bodily injury or death in connection with the use of YMCA facilities, and from any liability for other claims, including loss of property, to the fullest extent of the law.

8. I hereby assign and grant to the Lakeland Hills Family YMCA (and/or its' clients) all rights of every kind and character whatsoever to copyright and/or use, reuse, publish photographs or the name and/or likeness of me, or those included in my membership now or in the future, in which I/we/they may be included, in whole or in part, of composite or reproduction thereof in color or otherwise, still or moving, without restriction as to changes or alterations, for any commercial print or advertising purpose whatsoever, with no time restriction.

9. I understand that children age 11 and younger must have adult supervision at all times.

10. I understand that teens 12-14 years must attend a special orientation accompanied by a parent or legal guardian before using the weight & Fitness Training center.

11. I understand that the YMCA has the right to investigate or require proof of any information I have given on this application that qualifies membership eligibility, i.e. birthdate, relationship, residence, etc.

12. I understand that maintenance and renovation closings are considered part of membership and that this includes at least 2 weeks of complete facility facelift at the end of August/beginning of September.

Monthly Credit Card Draft Payment Plan Authorization


1. I authorize charges for fees for the membership account named above.

2. I understand that the drafts to my account will take place on or about the 15th of each month and it is my responsibility to check my credit card statement and report any discrepancies to the Membership Administrator within 15 days of the draft in question.

3. I understand that cancellation of new membership is not permitted within the first 12 months and I agree to fulfill payments that satisfy this minimum requirement regardless of whether I choose to discontinue usage. I understand that thereafter, in order to cancel this authorization, I must notify the Membership Administrator in writing and that this notice must be received no later than the 5th of the month in order to avoid being drafted again on the 15th.

4. I understand that this authorization is solely related to membership fees and does not extend to any additional fees related to enrollment in programs or other services.

5. I understand that it is my responsibility to notify the YMCA of any change in my credit card information, including the expiration date, and that changes must be submitted in writing no later than the 5th of the month.

6. I understand that should my monthly amount not be honored by my credit card account for any reason, I agree to be responsible for that payment plus a $25.00 service charge and I may be denied access to the YMCA until payment is satisfied.

7. I hereby authorize the Lakeland Hills Family YMCA to charge my credit card a monthly basis according to the terms above.

8. Please note that children who have reached the age of 24 will no longer be included in a Family Membership effective with the first draft after their 24th birthday. However, by upgrading to a Family + 1 Young Adult Membership, your child can remain on the family membership through the age of 25.