Membership Application – Gleason Family YMCA

Membership Application – Gleason Family YMCA

  • Basic Information































  • Emergency Contact Information













  • Recognition











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  • Membership Agreement


    In consideration of gaining membership or being allowed to participate in activities and programs of the Y and to use its facilities, equipment, and machinery, in addition to any fee or charge, I do hereby waive, release, and forever discharge the Y and its officers, agent, employees, representatives, (collectively "the Y"), from any and all responsibilities and liability for injuries or damages to myself, including those caused by the negligent act or omission of the Y, or in any way arising out of our connected with my participation in any activity at the Y or the use of equipment at the Y. I give permission for the Y to take photographs for use in Y promotional materials while I/we participate at YMCA SOUTHCOAST facilities. I agree to adhere to all policies set forth by the Y.
  • Monthly EFT Draft Membership

    • EFT draft is a continuous membership plan. I understand that this membership will remain in effect as long as I retain the membership card issued to me and that if I wish to terminate or change my membership in any way, I must give the Y a 30-day written notice. I understand that I must turn in all of my membership cards. A temporary card will be issued for the balance of the time I have paid or will be paying. The Y may, at their discretion, adjust the monthly rate applicable to my category of membership. I understand that I will receive at least four weeks notice prior to any change. I understand that I am still responsible for any payment plus the Y will apply a $20 service fee should an EFT draft be declined by my bank or other financial institution. This is in addition to any fee by my bank or financial institution.
  • Checking account draft information







  • Credit card draft information







  • Cancellation Policy

    All new members have a 30-day satisfaction guarantee. If you are not completely satisfied with service received at the Y, you will receive a full refund of your dues and joiner fee, when you notify us in writing that you wish to cancel your membership. This notification must be received no later than 30 days after your join date. Annual invoiced payment plans will only receive a full refund of membership if it is canceled within the first 30 days of joining. No prorated refund will be given if the membership is canceled after the first 30 days of joining. All EFT and credit card changes need to be made in writing 30 days prior to change. This includes cancellations, upgrades, downgrades, holds and billing changes. I hereby authorize YMCA SOUTHEAST to initiate electronic fund entries from my checking account or credit card until the Y receives a 30-day written notification from me indicating my desire to discontinue my membership.