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Membership application form
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FULL NAME(FIRST,MIDDLE,LAST) *
ADDRESS *
Age (full date of birth) *
Gender *
EMAIL *
PHONE NUMBER - LANDLINE, CELL *
HOBBIES
HEALTH: KINDLY STATE IF ANY ALLERGY, HEART CONDITON, EPILESY OF ANY OTHER COMMUNICABLE DISEASE. *
WERE YOU EVER A MEMBER OF THE 'Y' . IF YES, STATE PERIOD *
ACTIVITY REGISTRATION(activity, date&time, level) *
Emergency contact *
THE YMCA SHALL NOT BE RESPONSIBLE FOR ANY PROPERTY UNDER THE CONTROL OF MEMBERS AND/OR VISITORS WHICH IS LOST, STOLEN OR DAMAGED ON ITS PREMISES. NB. THE YMCA HAS RESPONSIBLE STAFF MEMBERS AND AS SUCH MONEY AND VALUABLES CAN BE LEFT WITH THEM.THE YMCA SHALL NOT BE RESPONSIBLE FOR INJURY SUSTAINED BY MEMBERS AND/OR VISITORS DUE TO THEIR OWN NEGLIGENCE OR OTHERWISE IMPROPER CONDUCT RESULTING FROM BREACH OF THE YMCA RULES.NB. THE YMCA HAS MADE SPECIAL ARRANGEMENTS WITH ANDREWS MEMORIAL HOSPITAL FOR TREATMENTS IN CASE OF EMERGENCY.  THE COST OF SUCH TREATMENT MUST BE MET BY THE INJURED PARTY.THE YMCA SHALL NOT BE RESPONSIBLE FOR ANY EXPENSES AND COSTS WHICH A MEMBER OR VISITOR MAY INCUR WHICH ARISES OUT OF THE USE OF THE PREMISES.I DESIRE TO BE ELECTED A MEMBER OF THE YMCA AND HEREBY AFFIRM MY COMMITTMENT WITH AND DESIRE TO CO-OPERATE IN THE OBJECTIVE AND PRINCIPLES FOR WHICH THE ASSOCIATION STANDS.
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