Membership Letter - YMCA of Northwest North Carolina

September 11, 2013
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 6 – Sunday, February 9.
As valued program participants, we would like to offer you three 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 Boot Camp classes, Teen Warriors, Next Level Sports
Performance Training and more, 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 three 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,
Adam Cardwell
ROBINHOOD ROAD FAMILY YMCA
Robinhood Road, Winston-Salem NC 27106
P 251 1090 F 336 251 1082 www.robinhoodymca.org
Our Mission: “Helping people reach their God-given potential in spirit, mind and body.” Financial Assistance available.

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: _______________________________________________
(PLEASE PRINT)
PARENT DATE OF BIRTH: ___________________
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: ___________________________________________ DATE: _________________
(PLEASE SIGN CLEARLY)
ROBINHOOD ROAD FAMILY YMCA
Robinhood Road, Winston-Salem NC 27106
P 251 1090 F 336 251 1082 www.robinhoodymca.org
Our Mission: “Helping people reach their God-given potential in spirit, mind and body.” Financial Assistance available.