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Thank you for your interest in joining the YMCA outdoor pool.
Please complete this form and a member service representative will contact you to finalize your pool membership.


Choose Your Branch

 

Choose Your Pool Membership

Membership Contact
First Name: Last Name: Birth Date: M/F:

Home Phone: Work Phone: Email: (red fields are mandatory)
Additional Family Members
Family Member #1
First Name: Last Name: Birth Date: M/F:
Family Member #2
First Name: Last Name: Birth Date: M/F:
Family Member #3
First Name: Last Name: Birth Date: M/F:
Family Member #4
First Name: Last Name: Birth Date: M/F:
Street Address: City: State: Zip:
Emergency Contact
First Name: Last Name: Home Phone:
Work Phone: Cell Phone: Relationship:
How did you hear about the YMCA?
Charge to Debit/Credit Card Account

VISA
Expiration Date (MM/YY):
Security Code:
Card Number:

MASTERCARD
Expiration Date (MM/YY):
Security Code:
Card Number:

AMERICAN EXPRESS
Expiration Date (MM/YY):
Security Code:
Card Number:

Informed Consent
I understand that the YMCA of the Brandywine Valley activities have inherent risks and I hereby assume all risks and hazards incident to my participation in all YMCA of the Brandywine Valley activities. I further waive, release, absolve, indemnify and agree to hold harmless the YMCA of the Brandywine Valley, the organizers, volunteers, supervisors, officers, directors, participants, coaches, referees, as well as, persons or parents transporting participants to and from activities from any claims or injury sustained during my participation in the YMCA of the Brandywine Valley activities. The YMCA is not responsible for lost or stolen property. I understand that my membership may be revoked if deemed necessary.

Photo Release
I agree to allow the YMCA of the Brandywine Valley to take photographs of those on this account. I give the YMCA permission to use these photographs on the YMCA web site, and in promotional, educational and fundraising materials. I have read this waiver and understand it.
I have read and understand the terms of this EZ-Pay agreement.