Day Use of Premise Agreement - South Sound YMCA

Rev. 12/2013
South Sound YMCA
Day Use of Premise Agreement
**Visitors must show I.D. before entering the facility**
Visitor Info: __________________ ___ _______________________ ____________ _________
First Name M.I. Last Name Date of Birth Male/Female
Address: _________________________________ __________________ _______ ____________
City State Zip Code
Home Phone #: ______________________ Cell Phone #: ___________________________
Work #: ____________________________ E-Mail Address:__________________________
Parent or Guardian Name (if participant is under 18):
_______________________________________________________
Emergency Contact Name:
__________________________________ Phone #: _________________
Have you or anyone on this application ever been convicted of a sexual offense against
In consideration of being permitted to utilize the facilities, premises, services and programs of
the YMCA (or for my children to so participate) for any purpose, including, but not limited to
observation or use of facilities, premises or equipment, or participation in any off-site program
affiliated with the YMCA, you agree to sign the Release and Waiver of Liability and Indemnity
Agreement each use.
__________________________________ ___________________________ _________________
Signature of Applicant/Parent/Guardian: Printed Date
__________________________________ ___________________________ _________________
Signature of 2nd Adult: Printed Date
The YMCA is committed to providing a safe and welcoming environment for all members and
guests. To promote safety and comfort for all, we ask individuals to act appropriately at all
times when they are in our facility or participating in our programs. Please read our code of
conduct on the back of this form.
Member Services Staff Use Only
Received by: _____________ Date: _________
Entered by:_______________ Date: ___________
I.D. Checked
Checked
Member #: ______________

Rev. 12/2013
South Sound YMCA
Member Code of Conduct
To assure a safe and pleasant visit to the YMCA:
Secure your valuables by locking them in a locker. The YMCA is not responsible for lost or stolen items.
Dress modestly and appropriately for the activity. Wear closed toe shoes with non marking soles. No heels or
sandals are allowed in work out areas. Swimsuits are required in pools, spas, saunas, and steam rooms. Shirts
are required in all program areas except on basketball courts during pick up basketball games.
Children 5 years and older must use a gender appropriate locker room.
While in the Downtown facility, all children under the age of 14 must be participating in a registered program
and/or supervised by a responsible person at least 18 years of age. While in the Briggs facility, all children under
the age of 9 must be supervised by a responsible person at least 16 years of age.
Children under 13 must pass a swim test before entering the deep end and must have a responsible adult in the
building. Non-swimmers must be within arms reach of a responsible adult at all times.
Eye protection is recommended while playing racquetball.
Follow all posted rules and directions of YMCA staff.
Prohibited actions specifically include, but are not limited to:
Inappropriate attire. Appropriate attire must be worn at all times.
Angry or vulgar language includes swearing, name-calling or shouting.
Physical contact with another person in any angry or threatening way.
Any demonstration of sexual activity or sexual contact with another person.
Harassment or intimidation by words, gestures, body language or any menacing behavior.
Photography, video or audio recording without prior approval of YMCA staff.
Theft or behavior that results in the destruction of property.
Carrying or concealing any weapons or devices or objects that may be used as weapons.
Using or possessing alcohol, tobacco products, or illegal substances on YMCA property, in YMCA vehicles, or at
YMCA sponsored programs. The YMCA and its property is a smoke-free environment.
Any other conduct of any inappropriate, threatening, or offensive nature.
Use of cellular phones where signage indicates they are not permitted.
Loitering is not permitted in or outside the YMCA.
The YMCA reserves the right to any access or membership to any person who has been convicted of any
crime involving sexual abuse, is or has been a registered sex offender.
Our code of conduct does not permit language or any action that can hurt or frighten another person, or
that falls below a generally accepted standard of conduct. Members and guests are encouraged to be responsible
for their personal comfort and safety, and to ask any person whose behavior threatens their
conduct to refrain. However, if a member or guest feels uncomfortable in confronting the person directly,
they should report the behavior to a staff person on duty.
YMCA staff members are eager to be of assistance. Members and guests should not hesitate to notify a
staff member if assistance is needed.
In order to be able to carry out these policies, we ask that members and guests identify themselves to
staff when asked.
The Branch Executive will investigate all reported incidents. Suspension or termination of YMCA membership
privileges may result from a determination by the Branch Executive if in their discretion a violation
of the YMCA Member Code of Conduct has occurred.