Guest Waiver Form




FOR YOUTH DEVELOPMENT®
FOR HEALTHY LIVING
FOR SOCIAL RESPONSIBILITY

Welcome to the YMCA! We are excited you have chosen to visit us and would like to get to know you a little better. Please complete the information requested below and when finished, inform a YMCA team member and provide them with a copy of your photo identification.




The main reason I visited today is…?

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Guest Waiver Form

I expressly acknowledge that there are certain dangers, risks, illnesses, personal injuries and death inherent in attending and/or participating in the YMCA’s programs, events, classes, and any other activities (including, but not limited to, individual exercise, strength training, group exercise, sports, challenges, competitions, horseback riding, self defense, archery, field trips, waterfront and pool activities, canoeing/boating, campfires, hiking, high ropes and other challenge courses) at and/or sponsored by the YMCA, which may result from falls, accidents or injuries, negligence of any person or organization, my participation in programs, events classes and any other activities, the use of any facilities and equipment, exercise, or from my or my minor child(ren)'s or ward (s)' physical condition (collectively, the “Activities”). I understand that the YMCA, and it's employees,agents, counselors, teachers, trainers, representatives, successors and assigns (collectively “Released Parties”) assume no responsibility for loss, damage, llness, injury or death to person or property that I or my minor child(ren) or ward(s) , if applicable, may sustain arising out of, resulting from or in any way connected with the Activities, including by reason of the active or passive negligence of any of the Released Parties. I expressly acknowledge, on behalf of myself and my minor child(ren) and ward(s), heirs and executors, that I voluntarily assume the sole risk for any and all loses, damages, illnesses, personal injuries or death that may result from my or my minor child(ren)'s or ward(s)' Activities at and/or sponsored by the YMCA. In consideration of the Released Parties allowing me and/or my minor child(ren) or ward(s) to attend and/or participate in the Activities, I hereby, for myself, my minor child(ren) or ward(s), heirs, and executors, waive,release and forever discharge the Released Parties from and against any and all rights and claims for any loss, damage, illness, injuries or death to person or property sustained arising out of,resulting from or in any way connected with the Activities, whether or not such loss, damage, illness, injury or death results from the negligence of the Released Parties or from some other cause. I also acknowledge that the Released Parties may use photographs, videotapes, television programs, motion pictures, tape recordings, or other similar media pertaining to the Activities for promotional purposes. I hereby consent to the use of my and/or my minor child(ren)'s or ward(s)' name(s) and/or likeness(es) in such materials to be exhibited and used for advertising, trade purposes, solicitation of patronage, promotional purposes, or other similar purposes, even if my and/or my minor child(ren)'s or ward(s)' name(s) and/or likeness(es) are an integral part of such photograph, videotape, television program, motion picture, tape recording, or other similar media. I further waive any and all rights to inspect or approve the photograph, videotape, television program, motion picture, tape recording or other use of my and/or my minor child(ren)'s or ward(s)' name(s) and/or likeness(es), including any written article, script, caption or other writing that may accompany such use of my and/or my minor child(ren)'s or ward(s)' name(s) and/ or likeness(es). I hereby, for myself, my minor child(ren) or ward(s), heirs, and executors, waive, release and forever discharge the Released Parties from and against any and all liability, claims, loses, costs, expenses or damages for libel, slander, invasion of privacy, conversation, defamation, appropriation of likeness or any other claim based on the use of my and/or my minor child(ren)'s or ward(s)' name(s) and/or likeness(es) in any such material. I hereby represent and warrant to the Released Parties that I have the authority to execute this Participant Waiver Form on behalf of myself and/or on behalf of my minor child(ren) or ward(s) as parent, guardian and/or next friend, if applicable. In the event of any misrepresentation or breach of the foregoing warranty by me, or in the event that I, my minor child(ren) or ward(s), or any other person nevertheless asserts any claim against the Released Parties arising out of my minor child(ren)'s or ward(s)' attendance or participation in the Activities as set forth herein, I agree to indemnify, hold harmless and defend the Released Parties from and against any and all liability, claims, loses, costs, expenses or damages resulting there from, including, but not limited to, claims of loss, damage, illness, injury or death to person or property whether or not such loss, damage, illness, injury or death results from the negligence of the Released Parties or from some other cause.

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