YMCA Parent/Guardian COVID Waiver

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

A parent/guardian must complete the waiver below on behalf of each youth under the age of 18 who will be visiting the YMCA. This waiver must be completed one time, after which a youth or parent may use our online reservation system to reserve space going forward. The YMCA of the North Shore will be opening up to youth and teen members in phases. Please refer to www.northshoreymca.org for current age guidelines.

Child's First Name *

Child's Last Name *

Child's Date of Birth *

YYYY

Parent/Guardian's First Name *

Parent/Guardian's Last Name *

Parent/Guardian's Email *

Please select your most frequently visited YMCA of the North Shore location: *

Plaistow Community YMCA

Haverhill YMCA

Ipswich Family YMCA

Cape Ann YMCA

Greater Beverly YMCA

Salem YMCA

Lynch/van Otterloo YMCA

Parent/Guardian's Primary Phone *

The Y is committed to a clean, safe, and healthy environment for our staff and members. This waiver is a requirement from our insurance company. We are following guidelines and are confident in our plans to keep staff and members safe. *

I fully understand both the known and potential dangers of utilizing the facilities, services, and programs of the YMCA and acknowledge that use thereof may, despite the YMCA’s reasonable efforts to mitigate such dangers, result in exposure to COVID-19.

I have read the Assumption of Risk, Release and Waiver of Liability: https://docs.google.com/document/d/1jS0571QgUURQVxewi0ubifjKUaXYTkcQ7xFqFga6ZCA/edit

Required

By electronically signing my full name below, I agree to the Assumption of Risk, Release and Waiver of Liability agreement on behalf of my child listed above. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of YMCA of the North Shore. Report Abuse

Forms