COVID Membership Program Application
Please provide your two most recent pay stubs for income verification.
Pay Stub Upload *
Maximum upload size: 2MB
By signing this form, I certify that the information provided to the YMCA is true and all income is reported. I also acknowledge it is necessary to notify the YMCA of any change in my income or financial support.
I understand that the COVID Membership Program runs for 6 months from my join date and that rates will automatically adjust to normal rates after the 6 month program period.
I authorize the Rappahannock Area YMCA to charge my account appropriately based upon the fee schedule outlined above.
Upon submission, you will be asked to fill out a Non-Member registration for our membership database. Please complete this step in order to expedite your COVID Membership Program processing.