Membership Waiver & EFT Agreement


Before completing the online membership process, please review the following and agree to the agreement.


The Peninsula Metropolitan YMCA is committed to providing the highest level of security to members. Personal information, payment information and other data transmitted through our system are encrypted using 128-bit SSL encryption technology. Security procedures are tested and reviewed on a regular basis using industry best practices. The YMCA does not share or sell information about our members for any purpose.


In consideration for being permitted to utilize the facilities, services, programs, and participation in the YMCA Nationwide Membership Program of the National Council of Young Men’s Christian Associations of the United States of America, and its independent and autonomous member associations in the United States and Puerto Rico, for any purpose, including, but not limited to, observation or use of facilities or equipment, or participation in any program affiliated with the YMCA without respect to location, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participation will, inspect and carefully consider such premises, facilities and affiliated program(s). It is further warranted that such entry into the YMCA or its programs for observation, or use of any facilities or equipment, or participation in such affiliated program(s) without respect to location, constitutes an acknowledgement that such premises, facilities and equipment thereon, and other such affiliated programs have been inspected and carefully considered, and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use, or participation.

1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT SUE the YMCA, its directors, officers, employees, and agents (hereinafter referred to as “releasees”) from all liability to the undersigned, his personal representatives, assignees, heirs, and next of kin for any loss or damage and any claim or demands therefore on account of injury to the person or property or resulting death of the undersigned, whether caused by the ordinary negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein, or participating in any program affiliated with the YMCA, without respect to location.

2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY, SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage or cost that may incur due to the presence of the undersigned in, upon, or about the YMCA premises or in any way observing or using any facilities or equipment of the YMCA or participating in any program affiliated with the YMCA, whether caused by the ordinary negligence of the releasees or otherwise.

3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE while in, about, or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon, or participation in any program affiliated with the YMCA.
THE UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of Virginia and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

THE UNDERSIGNED HAS READ, UNDERSTANDS, AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements, or inducements apart from the foregoing written agreement have been made.


YMCA membership is a continuous membership plan. Your membership remains in effect until terminated. If you are not satisfied with the quality of our services, please contact the Member Services Director at your branch. Membership Cards are the property of the YMCA and must be surrendered upon request. The safety and protection of Y members and guests is a paramount concern of the Peninsula Metropolitan YMCA; therefore, we reserve the right to deny access or membership to any person registered for sex offenses against children. The joining fee is a one-time fee as long as you remain an active member of the Peninsula Metropolitan YMCA. If you choose to cancel or discontinue your membership for more than 30 days, a joining fee will be charged when you reapply for membership. Rates are subject to change.

The YMCA conducts regular sex offender screenings on all members, participants, and guests. If a sex offender match occurs, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access.

It is understood that, if you choose to terminate or change your membership in any way, the YMCA must be given a 30-day written notice prior to your next billing date. Membership fees will not be refunded for non-usage. Members who are using the bank draft or credit card option to pay for their membership have 60 days past their last draft day to notify the YMCA of any discrepancy. All membership rates are subject to change with a 30-day written notice. It is your responsibility to notify the YMCA of change in address, credit card, or bank account information if utilizing recurring EFT or credit card options for payment of membership dues.

I acknowledge the waiver and membership agreement, and hereby apply for membership.


Periodically, photographs and videos are taken during our programs. These photographs and videos may be used for promotional items by the YMCA.

By checking the box below, you grant permission for photographs or videos of you and/or your family to be used. If at any time you do not want to be included in these, please notify the photographer.


I authorize Peninsula Metropolitan YMCA to charge or initiate transfer from the account I designate on a recurring basis for (membership/child care/programs/contribution) payments. If the payment date falls on a weekend or holiday, I understand that the payments may be executed on the next business day. Furthermore, this charge or transfer shall constitute notice of payment due and my receipt for payment. For ACH debits to my checking/savings account, I understand that these funds may be withdrawn from my account as soon as the periodic transaction date. In the case of an ACH transaction being rejected for Non-Sufficient Funds (NSF), I understand that Peninsula Metropolitan YMCA may attempt to process the charge again up to two times within 30 days of the return, and agree to an additional $25 charge for each returned NSF. This recurring payment will remain in effect until I notify the Peninsula Metropolitan YMCA in writing of any changes regarding my bank account/credit card or termination of this authorization at least 30 days prior to the next stated billing date.
I understand that my obligation under this agreement includes my recurring membership fees, NSF fees, contribution donations, and/or child care late fees. I acknowledge that all membership/child care rates are subject to change with a 30-day written notice from the YMCA, and recurring payment amounts may be adjusted on my account.
By typing your name, I certify that I am the authorized user of this bank account or credit card and will not dispute these scheduled transactions with my bank or credit card company so long as the transactions correspond to the terms indicated in this authorization form.

Our mission is to put Christian principles into practice through programs that build healthy spirit, mind and body for all.