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Membership & Fitness Application

We would love to have you as part of your village YWCA! A non-profit organization, everything that we offer is funded in large part by donations by community members like you. 100% of your membership fee stays at your YWCA to support our programming efforts, event planning, and building upkeep and improvement.

YWCA members enjoy benefits such as discounts on event registrations and tickets, discounted fitness memberships, advance notification of upcoming events, and so much more! Apply for membership today! If you would prefer, you can download and print a YWCA Membership Form to mail in, along with your payment in cash or check.

YWCA Westfield Membership & Fitness Application

"*" indicates required fields

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Date of Birth*

Preferred Phone*

Membership Type

What type of membership are you applying for?*

YWCA Membership

Fitness Center and Gymnasium Membership (Must be a YWCA member)

Gymnasium-Only Membership (Must be a YWCA member)

YWCA MEMBERSHIP

YWCA Membership Type*

1-Year YWCA Membership Is For*

FITNESS MEMBERSHIP (Must be a YWCA member)

Ages 16+, includes access to the gymnasium and fitness center. NOTE: You must be a member of the YWCA Westfield in order to join the fitness center.

Are you at least 16 years of age?*

Yes I am 16 or older

No I am under 16

Sorry, you must be 16+ to join the gymnasium and fitness center.

Fitness Center Membership Duration*

GYMNASIUM ONLY MEMBERSHIP (Must be a YWCA member)

Ages 16+ or accompanied by an adult. NOTE: You must be a member of the YWCA Westfield in order to join the gymnasium.

Gymnasium Only Membership Duration*

Emergency Contact for Fitness & Gymnasium Membership

Name

First Last

Relationship

Best Phone Contact

Senior Members

I am a participant of

Silver Sneakers

Silver & Fit

Other

My enrollment number is

Security Door PIN

Desired access PIN #

Secondary PIN #

Agreements

WESTFIELD MEMBERSHIP/FITNESS MEMBERSHIP WAIVER AND RULES OF MEMBERSHIP 1. MEMBER’S HEALTH WARRANTY: The Member warrants and represents that the Member has no disability, impairment, or ailment preventing her/him from engaging in active or passive exercise or that will be detrimental or adverse to such a person’s health, safety, or physical condition if she/he does so engage or participate. The Member acknowledges and agrees that: a. YWCA Westfield will rely on the foregoing warranty in issuing the Membership; b. YWCA Westfield shall have no obligation to perform a fitness assessment or similar testing to determine the Member’s physical condition; and c. YWCA Westfield shall not be liable for any injury arising from the Member’s disability, impairment or ailment preventing her/him from engaging in active or passive exercise, or that would be detrimental or adverse to such person’s health, safety or physical condition if she/he does so engage or participate. d. Each Member should be aware of her/his medical history and should consult a physician prior to engaging in exercise or continuing to exercise if a medical condition appears or appears to be developing. 2. LIABILITY AND WAIVER OF LIABILITY: Each member of YWCA Westfield shall be liable for any Property damage and/or personal injury (caused by a Member, Member’s Family, Guest or any other person) at YWCA Westfield or any activity or function operated, arranged or sponsored by YWCA Westfield. It shall be the obligation of the Member to pay for any costs involved upon presentation of a statement thereof. Any and all use of YWCA Westfield fitness facilities, or participation in YWCA Westfield activities operated , arranged or sponsored by YWCA Westfield either on or off YWCA Westfield premises by the Member, Member’s family or guest(s) shall be AT SUCH PERSON’S OWN RISK, and YWCA Westfield shall not be liable for any injuries or damages to such a person, or the property of such a person, or subject to any claim, demand, injury or damages. The Member Individually, or on behalf of the Member’s personal representative, heirs, administrators, assigns and successors does hereby expressly forever release and discharge YWCA Westfield, its successors and assigns as well as its officers agents and employees from all such claims, demands, actions, or causes of action. 3. SUSPENSION/TERMINATION OF MEMBERSHIP BY MANAGEMENT: Management has the right to suspend and/or terminate any membership for non-payment of dues, or for behavior inimical to the enjoyment of YWCA Westfield by other members and staff for any reason deemed sufficient in the sole discretion of Management. 4. MISSION: I understand that membership supports and furthers the Mission of the YWCA Westfield. 5. SECURITY: I understand that the PIN number assigned to my fitness membership is for my use only and that use of my PIN number by anyone other than myself will result in my PIN privileges being immediately revoked. 6. MINORS: I understand that all youth under the age of 18 may not enter the YWCA building unless accompanied by an adult YWCA member at all times and that YOUTH (UNDER THE AGE OF 18) MAY NOT ENTER THE FITNESS ROOM AT ANY TIME. 7. PHOTO RELEASE: On occasion, YWCA Westfield uses the names and pictures of its members for publicity.

COVID-19 WAIVER I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that YWCA Westfield, NY has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that YWCA Westfield, NY cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients and their families. I voluntarily seek services provided by YWCA Westfield, NY and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while in attendance. I attest that: * I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. * I have not traveled internationally within the last 14 days. * I have not traveled to a highly impacted area within the United States of America in the last 14 days. * I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. * I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non- contagious by state or local public health authorities. * I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. I hereby release and agree to hold YWCA Westfield, NY harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from YWCA Westfield, NY. I understand that this release discharges YWCA Westfield, NY from any liability or claim that I, my heirs, or any personal representatives may have against the YWCA Westfield, NY with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from YWCA Westfield, NY. This liability waiver and release extends to the YWCA together with all board members, partners, and staff. I understand that by using my PIN code to enter the YWCA building and the YWCA fitness center, that I agree to the above statements.

Signature*

Please type your name as well to agree*

First Last

Date*

Grand Total

Payment Method (Pay with Credit Card or PayPal)

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.

Membership & Fitness Application

YWCA Westfield Membership & Fitness Application

Membership Type

YWCA MEMBERSHIP

FITNESS MEMBERSHIP (Must be a YWCA member)

Sorry, you must be 16+ to join the gymnasium and fitness center.

GYMNASIUM ONLY MEMBERSHIP (Must be a YWCA member)

Emergency Contact for Fitness & Gymnasium Membership

Senior Members

Security Door PIN

Agreements

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Westfield YWCA Office