Membership Letter - YMCA of Northwest North Carolina

September 1, 2012
Dear Youth and Government Students and Parents,
Thank you for your participation in our YMCA Youth and Government Program! We appreciate the opportunity to
provide this “hands-on” experience in State Government, and look forward to the Youth Legislature that will be held
Thursday, February 14 – Sunday, February 17.
As valued program participants, we would like to offer you two free guest passes so that you can visit the Y to see
all we have to offer you and your family. High School students now have full access to use all areas of the building
including the Wellness Center, gym, pool, racquetball courts and track, as well as Group Exercise Classes.
Our knowledgeable and friendly staff can help you reach wellness goals like making the high school team or feeling
your best. Schedule a free Wellness Center Orientation for expert advice. We also offer additional classes and
programs on topics including weight lifting, sports clinics, nutrition and Teen Strength training, which you can sign
up for at the Welcome Center for an additional fee (offerings vary by branch). Something else you’re interested in
learning about? Let us know at the Welcome Center!
The two guest passes may be used at any of the following branches: Fulton Family YMCA, Jerry Long Family YMCA,
Robinhood Road Family YMCA or William G. White, Jr. Family YMCA. Please visit www.ymcanwnc.org for more
information on locations, hours of operations and class schedules. When you visit, remember to bring your guest
pass and a photo ID. If you are under age 16, please have your parent fill out our guest waiver (which you can find
on the back of this letter).
We look forward to seeing you at the Y!
Sincerely,
Erin Kennedy
Senior Program Director
Membership, Teens and Family
WILLIAM G. WHITE, JR. FAMILY YMCA
775 West End Boulevard, Winston-Salem NC 27101
P 336 721 2100 F 336 721 2106 www.wgwhiteymca.org
Our Mission: “Helping people reach their God-given potential in spirit, mind and body.”

Guest Pass Permission Waiver for Youth Under 16 Years of Age
YOUTH/TEEN’S NAME:__________________________________________________ DATE OF BIRTH:__________________
ADDRESS:__________________________________________________________________ Gender: M / F
(Please Circle)
CITY:_______________________________________STATE:____________ZIP:_______________________
PHONE NUMBER:___________________________________________________________
EMERGENCY CONTACT NAME:________________________________________________________
EMERGENCY CONTACT PHONE NUMBER:___________________________________________
Acknowledgment of Risk of Injury/Release and Waiver: By signing where indicated below, I
acknowledge and understand that there may be risk of injury involved in the activities I (and
any children under my supervision) may participate in during my (our) visit to the Branch
facility. I hereby agree to release, waive, discharge, covenant not to sue, hold harmless,
and indemnify the YMCA of Northwest North Carolina, Inc., the branch and their respective
agents, employees, officers, directors, members and other staff and personnel, and each of
their personal representatives, assigns, heirs and next of kin, from any loss, liability,
damage, or cost resulting from any and all injuries, claims, demands, actions or judgments
which I (and any children under my supervision) have had, or may have, or which my heirs,
executors or administrators may have or claim to have against the YMCA, the branch, their
respective successors or assigns, for all injuries, known or unknown, or injuries to property,
real or personal, known or unknown, caused by, arising out of, or related to my (our) use of
the Branch facility. I understand that if my child is not checked in to ChildWatch or the
Youth and Teen Center, he or she will not be directly supervised and may leave the branch
at any time.
PARENT NAME _______________________________________________ PARENT DATE OF BIRTH _________________
(PLEASE PRINT)
How did you hear about the Y? Radio Television Billboard Drive by/Live in
Area
Former Member YMCA Website Direct Mail Email Yellow Pages Newspaper
Medical Referral Friend/Family Other Website Facebook Magazine Place of
Employment Other Social Media
PARENT SIGNATURE:___________________________________________
(PLEASE SIGN CLEARLY)
DATE:_________________
WILLIAM G. WHITE, JR. FAMILY YMCA
775 West End Boulevard, Winston-Salem NC 27101
P 336 721 2100 F 336 721 2106 www.wgwhiteymca.org
Our Mission: “Helping people reach their God-given potential in spirit, mind and body.”