Alfred Campanelli YMCA

Online Membership Purchase

Informed Consent Form

Having attained the age of 18 years old, and desiring to become a member of the Alfred Campanelli YMCA, I agree to the following:

1. I understand that my participation in YMCA activities, regardless of location, is at my own risk. As such, I assume full responsibility for bodily injury, death, or property damage occurring out of my participation in YMCA activities.
   
   

2. I understand that monthly membership dues will be automatically deducted from the credit card account I select, in the amount stipulated. I further understand that I may cancel my membership at anytime with 15 days written notice to the YMCA. Furthermore, I understand that the YMCA must inform me in writing 30 days prior to raising membership dues.
   
   

3. I agree to notify the YMCA immediately upon change of address or change of credit card account information, including change of credit card number or expiration date.
   
   

4. I understand that on occasion photos may be taken for YMCA promotion/publicity; as such I give my permission for the use of my likeness in such promotion.
   
   

5. I agree to follow all YMCA rules as posted in the YMCA facility, or printed in YMCA promotional literature, or Member Handbook.

YES, I agree to the above .   NO, I do not agree to the above.

If you select NO above, online membership registration cannot be completed.