Be Our Guest

Second Guest's Name

First Name*

Middle Name

Last Name*

Second Guest's Date of Birth*

Second Guest's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Second Guest's Signature*

Type Signature

Draw Signature

Third Guest's Name

First Name*

Middle Name

Last Name*

Third Guest's Date of Birth*

Third Guest's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Third Guest's Signature*

Type Signature

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Fourth Guest's Name

First Name*

Middle Name

Last Name*

Fourth Guest's Date of Birth*

Fourth Guest's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Fourth Guest's Signature*

Type Signature

Draw Signature

Fifth Guest's Name

First Name*

Middle Name

Last Name*

Fifth Guest's Date of Birth*

Fifth Guest's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Fifth Guest's Signature*

Type Signature

Draw Signature

Sixth Guest's Name

First Name*

Middle Name

Last Name*

Sixth Guest's Date of Birth*

Sixth Guest's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Sixth Guest's Signature*

Type Signature

Draw Signature

Seventh Guest's Name

First Name*

Middle Name

Last Name*

Seventh Guest's Date of Birth*

Seventh Guest's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Seventh Guest's Signature*

Type Signature

Draw Signature

Eighth Guest's Name

First Name*

Middle Name

Last Name*

Eighth Guest's Date of Birth*

Eighth Guest's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Eighth Guest's Signature*

Type Signature

Draw Signature

Ninth Guest's Name

First Name*

Middle Name

Last Name*

Ninth Guest's Date of Birth*

Ninth Guest's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Ninth Guest's Signature*

Type Signature

Draw Signature

Tenth Guest's Name

First Name*

Middle Name

Last Name*

Tenth Guest's Date of Birth*

Tenth Guest's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Tenth Guest's Signature*

Type Signature

Draw Signature

Guest's Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Parent's or Guardian's Email Address

Email*

Yes, I'd like to receive YMCA news and information.

A signed copy of this waiver will be sent to the email address you provide.

Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

I am...

YMCA of WNC Liability Waiver

MEMBERSHIP WAIVER/ASSUMPTION OF THE RISKS

I, on behalf of myself, members of my household or minor children, and any heirs and assigns, guardians, executors, administrators, and legal representatives of me, members of my household or minor children ("Releasing Parties"), waive and release any and all rights and claims for damages, demands, and any other actions whatsoever, including those attributable to simple negligence, that any of the Releasing Parties may have against the YMCA of Western North Carolina and its agents, employees, contractors, volunteers, representatives, successors, and assigns ("YMCA"), for any and all injuries or damage, which may arise out of or in connection with Releasing Parties' use of any YMCA facilities or participation in any YMCA activities and programs. I agree to indemnify and hold harmless the YMCA and understand that the YMCA assumes no responsibility or liability for any injuries, illness, or damage that Releasing Parties may sustain as a result of any physical condition of Releasing Parties, or resulting from Releasing Parties' observation or participation in any YMCA activity, or use of any YMCA facilities, or equipment. I expressly acknowledge on behalf of Releasing Parties that Releasing Parties assume the risk for any and all injuries, illness, and damage that may result from Releasing Parties participation in these activities. I/RELEASING PARTIES FURTHER VERIFY THAT I/RELEASING PARTIES HAVE FULL KNOWLEDGE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THE YMCA ACTIVITIES AND PROGRAMS. I/RELEASING PARTIES EXPRESSLY, KNOWINGLY, AND VOLUNTARILY ASSUME THE RISKS INVOLVED IN THE ACTIVITIES AND PROGRAMS AND AGREE TO HOLD THE YMCA HARMLESS FOR ANY RESULTING INJURY. I understand that this waiver and assumption of the risk shall remain in effect until notice of cancellation is received by the YMCA. I further understand that should I decline to execute this agreement, I will not be permitted to attend or participate in the activities and programs.

If my membership is eligible to participate in the YMCA Nationwide Membership Program, I understand that by participating in the YMCA Nationwide Membership Program, I/Releasing Parties 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.

OTHER CONDITIONS OF MEMBERSHIP/PROGRAM PARTICIPATION

The YMCA has the right to suspend and/or terminate any membership or program participation for violation of any posted or written rules of conduct, for any behavior that interferes with the enjoyment of the YMCA by others, and for any inappropriate behavior at the YMCA, including but not limited to sexual conduct, abusive or threatening language, theft, fighting, or assault. YMCA memberships are nontransferable. The YMCA conducts regular sex offender screenings on all members, participants, and guests. If a match occurs on the registry, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access. The YMCA has the right to suspend and/or terminate any membership/program participation at any time. Members must present their membership card or verify their identity for entry into any facility. The management of the YMCA has the right to suspend and/or terminate any membership for nonpayment of fees.

PHOTO/AUDIO VISUAL/NARRATIVE RELEASE

For my participation in activities to be conducted by the National Council of Young Men's Christian Associations of the United States of America ("YMCA of the USA") or any of its chartered member associations in the United States (collectively "the Y"), and collaborating third parties, I consent, now and for all time, to the making, reproduction, editing, broadcasting or rebroadcasting of video film or footage of me, sound track recordings of me, photo reproductions of me, and any narrative account of my experience. My consent includes a perpetual license to the Y and collaborating third-parties for the use of the above materials for publication, display, sale or exhibition in promotions, advertising, education and commercial uses. Use includes reproductions in any form and media currently existing or later conceived, adaptations and/or revisions, throughout the world in perpetuity.

I understand and agree there may be no additional compensation for this license, and I will not make any claim for payment of any kind from the Y or collaborating third-parties. I may, or may not be, identified in such licensed uses; however, my name will not be used to endorse any particular products or services. With respect to any of the above uses, I further agree that all works shall belong to YMCA of the USA; the Y has no duty of confidentiality regarding any licensed uses; YMCA of the USA shall exclusively own all known or later existing rights to the uses throughout the world; photo reproductions of me and/or my narrative account for any purpose without additional compensation to me. I agree that my consent is irrevocable. I hereby release and discharge The Y and collaborating third-parties, from any and all claims, actions, lawsuits or demands of any kind arising out of my consent, license grants, uses, or the shared uses of any works or materials referenced herein.

PROGRAM PARTICIPATION WAIVER/ASSUMPTION OF THE RISKS

I, on behalf of myself and minor children, and any heirs and assigns, guardians, executors, administrators, and legal representatives of me, members of my household or minor children ("Releasing Parties"), waive and release any and all rights and claims for damages, demands, and any other actions whatsoever, including those attributable to simple negligence, that any of the Releasing Parties may have against the YMCA of Western North Carolina and its agents, employees, contractors, volunteers, representatives, successors, and assigns ("YMCA"), for any and all injuries or damage, which may arise out of or in connection with Releasing Parties' use of any YMCA facilities or participation in any YMCA activities and programs. I agree to indemnify and hold harmless the YMCA and understand that the YMCA assumes no responsibility or liability for any injuries, illness, or damage that Releasing Parties may sustain as a result of any physical condition of Releasing Parties, or resulting from Releasing Parties' observation or participation in any YMCA activity, or use of any YMCA facilities, or equipment. I/RELEASING PARTIES FURTHER VERIFY THAT I/RELEASING PARTIES HAVE FULL KNOWLEDGE OF THE RISKS ASSOCIATED WITH PARTICIPATING IN THE YMCA ACTIVITIES AND PROGRAMS. I/RELEASING PARTIES EXPRESSLY, KNOWINGLY, AND VOLUNTARILY ASSUME THE RISKS INVOLVED IN THE ACTIVITIES AND PROGRAMS AND AGREE TO HOLD THE YMCA HARMLESS FOR ANY RESULTING INJURY. I understand that this waiver and assumption of the risk shall remain in effect until notice of cancellation is received by the YMCA. I further understand that should I decline to execute this agreement, I/Releasing Parties will not be permitted to attend or participate in the activities and programs.

OTHER CONDITIONS OF MEMBERSHIP/PROGRAM PARTICIPATION

MEMBERSHIP WAIVER/ASSUMPTION OF THE RISKS

OTHER CONDITIONS OF MEMBERSHIP/PROGRAM PARTICIPATION

PHOTO/AUDIO VISUAL/NARRATIVE RELEASE

PROGRAM PARTICIPATION WAIVER/ASSUMPTION OF THE RISKS

OTHER CONDITIONS OF MEMBERSHIP/PROGRAM PARTICIPATION

PHOTO/AUDIO VISUAL/NARRATIVE RELEASE

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.

Parent's or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*

Parent's or Guardian's Date of Birth*

Parent's or Guardian's Information

Are you currently a resident of Western North Carolina?

Ethnic background*

If Other, please list

Gender

Branch I will be visiting*

Parent's or Guardian's Signature*

Type Signature

Draw Signature