Group Membership Agreement

YMCA of Delaware

100 W. 10th Street

Wilmington, DE 19801

Date:

Branch:______

Agency/group:

Person(s) Responsible:

Relationship to group:

Terms of the group membership

Initial each box:

Agency must provide Federal Tax ID
Agency will choose one of the following options:
______Option 1: Membership cards will be issued to specific participants whose personal information (name, address, date of birth) will be attached to that card.
______Option 2: Membership cards will be shared among various group participants. In this instance, each participant will bring the agency membership card and sign in the guest log at each visit and sign an informed consent annually. If over age 18, participant will bring their photo ID at each visit.
The maximum number of participants for each family membership is six (6): One (1) staff and five (5) participants.
The membership is only to be used to benefit the participants in the Group program.
Memberships cannot be used by staff to participate at the YMCA independently of or during group participation.
All group memberships are valid at all branches of the YMCA of Delaware.
To prevent re-payment of the joiner fee, membership(s) must be kept current.
Visits to the facility are limited to once per day per card
While the group participants are using the YMCA facility they will support the Mission of the YMCA and demonstrate good sportsmanship and cooperation and follow all posted rules and guidelines.
For groups with participants under age 18, staff will directly supervise participants:

On the pool deck when participants are in the pool.
In the fitness center when participants are using the fitness center equipment.
In the locker rooms before and after activities to supervise participants.
In the gym, walking track, and/or courts.

To facilitate locker room supervision, youth groups with male and female participants must have a minimum of two family memberships for a male and female staff.
Participants will be asked to leave collateral to borrow equipment (e.g. basketballs, racquets) such as keys; ID and membership cards cannot be left as collateral. All equipment that is borrowed will be returned in clean and serviceable condition.

Summary of charges

Number of family memberships: ______

Valid from ______through ______

Cost per membership: $100/month

Joiner fee: $90

Total cost: ______

Payment method: ______Paid in full ______EFT/monthly charge

I,______(printed name of person responsible), agree to the above terms and conditions. I will serve as the contact person should the YMCA need to communicate with our agency, and I will ensure that our group fully cooperates with all YMCA conditions and rules. I will also be asked to sign an informed consent at the time that the membership is activated.

______

Group Responsible Party’s SignatureDate

______

YMCA Staff Signature Date