MEMBERSHIP APPLICATION Please select membership type: * 1. PRIMARY ADULT (OR PARENT/GUARDIAN FOR APPLICANT UNDER 18 YEARS OF AGE) Birthdate (mm/dd/yyyy): * Gender: * Email: * Home Phone: * Cell Phone: Emergency Contact Name: * Emergency Contact Phone: * Employer: What brought you to the Y? 2. SECOND ADULT MEMBER (INCLUDED IN FAMILY AND SENIOR COUPLE MEMBERSHIP) Gender: Birthdate (mm/dd/yyyy): Phone: Email: Employer: DEPENDENT CHILDREN (25 YEARS OF AGE OR YOUNGER) 1. CHILD'S NAME (First and Last) Gender: Birthdate (mm/dd/yyyy): 2. CHILD'S NAME (First and Last) Gender: Birthdate (mm/dd/yyyy): 3. CHILD'S NAME (First and Last) Gender: Birthdate (mm/dd/yyyy): 4. CHILD'S NAME (First and Last) Gender: Birthdate (mm/dd/yyyy): 5. CHILD'S NAME (First and Last) Gender: Birthdate (mm/dd/yyyy): BANK/CREDIT CARD MONTHLY DRAFT AGREEMENT
Once your application is submitted, we will contact you with instructions to set up an online account and add your payment method. You will also be required to sign a Member Release and Waiver of Legal Liability and Code of Conduct before using the facility or participating in programs. If you have any questions, please contact email@example.com.
1. The bank/credit card draft plan is a continuous membership plan. The monthly amount is withdrawn on the 15th of each month for the current month. Please initial below: * 2. It is my understanding that if I wish to cancel, I must give the YMCA 30 days' written notice prior to the draft date. If I wish to change my membership type, I must give the YMCA written notice prior to the 25th of the prior month. Please initial below * 3. I understand that my membership will be paid from the bank account/credit card of the person listed below on the 15th of the month. Should any membership draft not be honored by my bank or credit card for any reason, I realize that I am still responsible for that payment plus a $25.00 service charge applied by the YMCA. This is in addition to any service fee my bank may charge. Please initial below: * 4. I understand that it is my responsibility to notify the Y in writing of any changes to my bank/credit card accounts. Please initial below: * 5. The YMCA Board of Directors may, at their discretion, adjust the monthly rate applicable to my membership category. I understand that I will receive at least 60 days' notice prior to any rate changes. Please initial below: * 6. All membership fees are non-refundable. I have read the above bank/credit card draft agreement and understand the bank/credit card monthly draft process. Please initial below: * PLEASE SIGN THE BANK/CREDIT CARD DRAFT AGREEMENT BY ENTERING YOUR NAME BELOW: * Today's Date (mm/dd/yyyy): * ANNUAL SUPPORT
The Fanwood-Scotch Plains YMCA is dedicated to improving the quality of life of the individuals, families, and communities we serve, through programs and services that build wholeness of spirit, mind and body. The YMCA is a not-for-profit organization founded on Christian principles, serving people of all ages, races, faith, cultures, and socio-economic conditions. Our goal is to ensure that no one is denied a chance to participate at the Y because of an inability to pay. Please consider making a gift to our Annual Support Campaign at fspymca.org/giving or adding a donation to your monthly draft.
I would like to contribute to the Fanwood-Scotch Plains YMCA Annual Support Campaign by adding the following amount to my monthly draft. Please enter amount per month below. Please sign by entering your name below: Today's Date (mm/dd/yyyy):