I give the YMCA of Greater Omaha permission to draft my bank account or credit card account per the terms outlined on this form.
I understand that my account will be drafted each month and if my draft is returned unpaid I will be responsible for the payment amount and any penalties incurred.
Electronic collection efforts may be handled by an outside agency and my account will be assessed an additional maximum fee of $30.00.
BANK DRAFT AND CREDIT CARD CANCELLATIONS MUST be submitted to the YMCA in writing prior to the 25th of the current month in order to avoid being
drafted the following month. The YMCA will notify you of any changes to the draft. Your membership is continuous until you stop it.
RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT
In consideration for being permitted to utilize the facilities, services and programs of the YMCA for any purpose, including but not limited to observation or use of
facilities or equipment, participation in any program affiliated with the YMCA, without respect to location, the undersigned, for himself and 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 participating will inspect and
carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the YMCA for observation or use of any facilities or
equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated
programs have been inspected and carefully considered and that the undersigned finds and accepts same as being safe reasonably suited for the purpose of such
observation, use or participation.
Individuals who are listed on a sex offenders registry are not allowed to participate in any YMCA memberships or program activities.
IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER THE YMCA 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 HEREBY AGREES TO THE FOLLOWING:
1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA, its directors, officers, employees, and agents
(hereinafter referred to as “releases”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim
or demands there for on account of injury to the persons or property or resulting in death of the undersigned, whether caused by the negligence of the releases or otherwise
while the undersigned is in, upon, or about the premises or any facilities or equipment therein, or participation in any program affiliated with the YMCA, without respect to
2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them for any loss, liability, damage,
or cost they 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 negligence of the releases or otherwise.
3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY , DEATH OR PROPERTY DAMAGE due to
negligence of releases or otherwise 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 forgoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as
is permitted by the law 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 AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further
agrees that no oral representatives, statements, or inducement apart from the foregoing written agreement have been made.