Membership Waivers Membership Waivers Legal Name*Name as it appears on your billing information. First Last Membership Type*Please select one from the list below.YouthAdultFamilySeniorRelease and Waiver of Liability and Indemnity Agreement*In consideration for being permitted to utilize the facilities, services, and programs of the YMCA for any purpose, including but not limited to observation or use of facilities or equipment, or participation in any program affiliated with the YMCA, without respect to location, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated programs have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use, or participation. IN FURTHER CONSIDERTION OF BEING PERMITTED TO ENTER THE YMCA FOR ANY PURPOSE, INCLUDING BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH THE YMCA, WITHOUT RESPECT TO LOCATION, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING: 1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA, its directors, officers, employees, and agents (hereinafter referred to as “releases”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releases or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein, or participating in any program affiliated with the YMCA, without respect to location. 2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in, upon, or about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA whether caused by the negligence of the releases or otherwise. 3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to negligence or releases or otherwise while in, about, or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA. THE UNDERSIGNED further expressly agrees that the forgoing RELEASE, WAIVER and INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of Maine and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE SIGNED HAS READ AND VOLUNTARILY AGREES TO THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements, or inducement apart from the foregoing written agreement have been made. By agreeing below, I acknowledge that I am a member of the Bath Area Family YMCA and, as such, am supportive of its mission and its purpose. I understand that membership is non-refundable after 30 days from membership application date. I also understand that any member listed or my guests who fail to follow the established YMCA policies can be cause for the YMCA to terminate my membership privileges without refund. I also give my permission for any person listed on the membership application to receive proper medical treatment, unless otherwise noted in writing. Yes, I agree to the terms of the Release and Waiver of Liability and Indemnity Agreement Release and Waiver of Liability and Indemnity Agreement* Yes, I agree to the terms of the Release and Waiver of Liability and Indemnity Agreement for My Children who are Minors YMCA Credit Card/Debit Card Membership Payment Agreement*1. Y-bank is a continuing membership plan. I understand that this membership will remain in effect for as long as I retain the membership card issued to me. 2. It is to my complete understanding that if I wish to cancel or change my membership in any way, I must give the YMCA a 15-day written notice prior to my draft date. It will be my responsibility to notify the YMCA of any changes to my account. (i.e. new account numbers, new credit or debit card numbers and expiration dates) 3. The YMCA Board of Directors may, at their discretion, adjust the monthly rate applicable to my category of membership. I understand that I will receive at least four weeks notice prior to any such change. 4. Should any membership draft not be honored by my bank/credit card company for any reason. I realize that I am still responsible for that payment plus a service charge of $15 applied by the YMCA. This is in addition to any service fee my bank/credit card company may charge. The rejected membership payment and service charge will be automatically resubmitted to your bank/credit card company. If there is a second rejection, you will be required to pay the membership payment and fees with an alternate form of payment and your membership may be terminated. I hereby authorize the Bath Area Family YMCA to draft the account indicated on the date indicated on a monthly basis until the end of the membership term.