Two Week Free Trial

Two Week Free Trial Registration Form

Two Week Free Trial Registration Form

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The Rappahannock Area YMCA is committed to providing a safe and welcoming environment for all members, participants and guests participating in our programs and/or using our facilities. To promote safety and comfort for all, individuals are expected to act appropriately at all times when they are in our facility, on our property or participating in our programs and to adhere to the values of the YMCA caring, honesty, respect and responsibility. Members and participants shall pay all amounts due to the YMCA in full and on time. We expect persons using the YMCA to behave in a mature and responsible way, and to respect the rights and dignity of others, including YMCA staff. Our Code of Conduct does not permit language or any action that can hurt or frighten another person, or that does not adhere to a generally accepted standard of conduct. The Rappahannock Area YMCA reserves the right to deny access or membership to any person whose behavior does not conform to our Member Code of Conduct. Prohibited actions include, but are not necessarily limited to: Inappropriate attire. Appropriate attire must be worn at all times. Angry or vulgar language, including swearing, name-calling or shouting. Physical contact with another person in any angry or threatening way. Any demonstration of sexual activity or sexual contact with another person. Harassment or intimidation by words, gestures, body language or any menacing behavior. Theft or behavior that results in the destruction of property. Carrying or concealing any weapons or devices or objects that may be used as weapons. Using or possessing illegal narcotics or alcohol on YMCA property, in YMCA vehicles, or at YMCA sponsored programs. Refusal to verify identity when asked by YMCA staff. Failure to follow verbal or written directions of YMCA staff. Abusive or disrespectful conduct toward YMCA staff. Conduct inconsistent with the YMCA core values of caring, honesty, respect and responsibility. Interference with respect to the management or operations of the YMCA. Unsafe practices or behavior on YMCA property or when utilizing YMCA facilities or equipment. Any other conduct of an inappropriate, threatening or offensive nature. Loitering is not permitted in or outside the YMCA. The YMCA is a smoke-free environment. Smoking is not permitted in YMCA facilities or on YMCA property. Members, participants and guests are encouraged to be responsible for their personal comfort and safety, and to ask any person whose behavior threatens their comfort to refrain. If a member, a participant or guest feels uncomfortable in confronting the person directly, the matter should be reported to a staff person or the Building Supervisor on duty who are eager to be of assistance. Members, participants and guests should not hesitate to notify a staff member if assistance is needed. The YMCA reserves the right to deny access or membership to any person who has been accused or convicted of any crime involving violence, sexual abuse or behavior, is a registered sex offender, has ever been convicted of any offense relating to the use, sale, possession, or transportation of narcotics or habit forming and/or dangerous drugs, is under the influence (whether currently or habitually) of narcotics, chemicals, intoxicating beverages and/or habit forming or dangerous drugs, or whose behavior does not conform to this Member Code of Conduct. The YMCA conducts regular sex offender screenings on all members. If a sex offender match occurs, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access. The Branch Executive will investigate all reported incidents. Suspension or termination of YMCA membership, participation or guest privileges may result from a determination by the Branch Executive if in his/her discretion a violation of the YMCA Member Code of Conduct has occurred. This Member Code of Conduct is subject to modification at the discretion of the Rappahannock Area YMCA. Release, Waiver of Liability and Indemnity Agreement: By participating in the YMCA Nationwide Membership Program, I agree to release the National Council of Young Men's Christian Associations of the United States of America, and its independent and autonomous member associations in the United States and Puerto Rico, from claims of negligence for bodily injury or death in connection with the YMCA facilities, and from any liability for other claims, including loss of property, to the fullest extent of the law. 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, or participation in any program affiliated with the YMCA, without respect to location, for himself or herself as well as on behalf of any individuals included on this program registration and any personal representatives, heirs, and next of kin (the Undersigned), the Undersigned hereby acknowledges, agrees and represents that the Undersigned has, or will immediately upon entering or participating, 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 acknowledgment 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 and reasonably suited for the purpose of such observation, use, or participation. 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: 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 for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the Undersigned, which is in any way associated with the Undersigned's presence in, upon, or about the premises or any facilities or equipment therein, or participation in any program affiliated with the YMCA, without respect to location. The Undersigned hereby agrees to indemnify, save and hold harmless the Releases and each of them from any loss, liability, damage, or cost they may incur which is in any way associated with the Undersigned's presence 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. The Undersigned hereby assumes full responsibility for and risk of bodily injury, death, or property damage which is in any way associated with the Undersigned's presence in, about, or upon the premises of the YMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the YMCA.
The Undersigned further expressly agrees that the foregoing RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT is intended to be as broad and exclusive as permitted by law of the state of Virginia and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements, or inducement apart from the foregoing written agreement have been made. The UNDERSIGNED acknowledges that the Rappahannock Area YMCA is a charitable non-profit organization under the laws of the State of Virginia and nothing in this RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT shall be construed as a waiver of charitable non-profit status and/or benefits under Virginia law. I have read and understood all of the above, and the information I have provided is correct to the best of my knowledge.

Membership Agreement: I understand that all membership fees are non-refundable. I understand that when payment is made by check, the Rappahannock Area YMCA is authorized to use the information from my check to initiate a one-time Electronic Funds Transfer from my bank account. I further understand that these funds may be withdrawn from my account as soon as the day after the YMCA receives my check, that I will not receive my check back from my financial institution, and that I am responsible for any return fees applied should my bank not honor the EFT debit. Should any membership draft be declined for any reason, I realize that I am still responsible for that payment plus a service charge at the current rate, applied by the YMCA. This is in addition to any service fee my bank may charge. I further realize that my account will be automatically re-drafted for any payment of a draft not honored. I understand that all changes affecting my monthly draft, (e.g. billing information, holds, downgrades, termination) require 30 days written notice before my next draft date. Any error must be identified no later than 60 days from the posted bank statement date. The YMCA is not responsible for errors occurring later than 90 days from the date of the initial error. The YMCA draft is a continuous membership plan. I understand that this membership will remain in effect until properly terminated with the YMCA. The YMCA Board of Directors may, at their discretion, adjust the monthly membership rate applicable to my category of membership. I understand that I will receive at least 30 days notice of the change before a debit occurs at the new rate. I understand my home branch will be determined by facility usage, which will be monitored bi-annually. In the event my home branch changes, I understand I will receive at least 30 days notice of the change before a debit occurs at the new rate. Membership changing from Student to Adult (19 years old) and from Adult to Senior Adult (62 years old) will automatically renew to the appropriate monthly rates during the first draft at which the primary member has reached the aforementioned age. Members with family memberships will need to notify Member Services when their memberships are due to convert to the senior family membership.

External Privacy NOTICE
This privacy notice will advise you about our guidelines concerning the use of your personal information, including the reasonable efforts we make to protect your personal information in accordance with these guidelines, and about what choices you have concerning our use of such information. Please read this notice carefully. Effective Date: 00/00/0000 Category: PRIVACY Contact(s): First & Last Name Title Local YMCA Email

We keep your private information private by Not selling your information. You have entrusted the National Council of Young Mens Christian Associations of the United States of America and its independent and autonomous member associations (collectively The Y) with your personal information, and we're committed to using it wisely. The Y will not sell, share or otherwise transfer your personal information to anyone without your consent.
Restricting who has access to your information
The Y takes reasonable precautions to restrict access to your Internet account and personal information only by employees who are authorized to have such access for business purposes. If you have any questions or concerns about our privacy policy, please contact us at [insert email address, phone number, and/or address]. Please refer to this policy regularly. The Y may need to change this policy from time to time to address new issues and reflect changes on our websites or within YMCA branches. We will post material changes on our websites or otherwise notify you and update the Last Date Updated field in the Revision History at the bottom of this page so that you will always know our policies regarding what information we gather, how we might use that information, and whether we will disclose that information to anyone.

Scope of Privacy Policy
This policy applies to the personal information that you provide to The Y, either through our websites and mobile applications or in person at a YMCA branch or program site. This policy does not apply to your use of unaffiliated sites to which our websites link. This policy does not apply to Personal Health Information (PHI) collected through the YMCA Diabetes Prevention Program or any other program offered by The Y that requires the collection of PHI or other HIPPA protected information.

Collection of Personally Identifiable Information
The Y collects personally identifiable information (PII) from you when you voluntarily submit such information to us. The collection of PII may occur in person or on a website or mobile application operated, provided or otherwise controlled by The Y. This information may include your name, home address, email address, telephone number, date of birth, demographic information, sex-offender status, membership status, emergency contact information, and other information that we may need to collect in connection with certain events, including but not limited to: registration for, or participation in, events, classes, camps, and other activities or programs offered by The Y, participation in YMCA Nationwide Membership registration for surveys, forums, content submissions, chats, bulletin boards, discussion groups, requests for suggestions, or other services or activities offered on our website answering your inquiries about our websites, organization, membership, or other services or activities, registration as a member of The Y.

Collection of Photographs
The Y may also collect your photograph, by capturing your image at a YMCA or scanning your personal identification card, for the purpose of identifying you as a member, volunteer or program participant. Your photograph will not be used for any commercial purpose without your authorization, and shall not be retained longer than three years from your last interaction with The Y.

Use and Disclosure of PII
If you do provide us with PII, The Y may contact you based on the information you provide to communicate with you about YMCA activities that may be of interest to you and your family. The Y will use its best efforts to never disclose any PII about you to any third-party for purposes unrelated to the YMCA without having received your permission except as provided for herein or otherwise as permitted or required under applicable law. We do not rent or sell PII, including information provided about children, to third-parties. The Y may share PII with trusted service providers, such as payment processors, technology partners or other providers that need access to your information to provide operational or other support services while you are a YMCA member or program participant. In certain circumstances, we may also share information with select similar nonprofit organizations that may offer activities of interest to you. We may also provide PII to regulatory authorities and law enforcement officials in accordance with applicable law or when we otherwise believe in good faith that the provision of such information is required or permitted by law, such as in connection with the investigation or assertion of legal defenses or for compliance matters.

Collection of Payment Transaction Information
When you make a payment or donation, we collect information to process the financial transaction and may use that information to contact you in the future about The Y and its programs. Your payment information is transmitted to us, using a secure Internet method that helps maintain the privacy of this information. During the time your payment information resides on our computers, it is in an encrypted format and can only be accessed by authorized personnel with a decryption key.

Collection of Non-Personally Identifiable Information
We collect non-personally identifiable information without limitation, through the use of the following types of methodology: Cookie technology: A cookie is an element of data that a website can send to your browser, which may then store it on your system to help enhance your experience in using our sites and to provide us with technical information about your usage. IP address tracking: An IP address is a number that is assigned to your computer when you are on the Internet. When you request pages from our Sites, our servers log your IP address. Web beacons: A web beacon, or clear gif, is a small graphic image on a web page or web-based document that a website can use to determine information about a user. Non-personally identifiable information might include the browser you use, the type of computer you use, technical information about your means of connection to our websites (such as the operating systems and the Internet service providers utilized), and other similar information. Our systems may also automatically gather information about the areas you visit and search terms you utilize on our websites and about the links you may select from within the sites to other areas of the World Wide Web or elsewhere online. Although an industry-standard do-not-track (DNT) protocol has not yet been established, The Y's information collection and disclosure practices and the choices it offers to consumers will continue to operate as described in this Policy.

Use of Non-Personally Identifiable Information
We use non-personally identifiable information for our purposes related to running YMCA's and their programs, and, in particular, to administering websites, and, in the aggregate, to determine what technologies are being used. We may also share aggregate, non-personally identifiable information with third-parties.

Collection of Sensitive Information
Where necessary, The Y may collect certain sensitive information from you, including payment card or bank account information to process fees or donations, health information in connection with various fitness programs, programs in which we are responsible for supervising children, health screenings, or other health service events that we may provide from time to time. Access to sensitive information is restricted to those individuals who have a legitimate need for access. We will not use or disclose your information to third-parties unless such disclosure is necessary to accomplish the purpose for which the information is collected.

Privacy of Children
We are mindful that young people need special safeguards and privacy protection. We realize that they may not understand or be able to meaningfully consent to the provisions of our policy or be able to make thoughtful decisions about the choices that are made available to our adult users. We strongly urge all parents or legal guardians to participate in their childrens exploration of the Internet and any online services and to teach their children about protecting their personal information while online. To provide the services we offer, we sometimes need to collect certain information about children in both online and offline contexts. If we ask for PII from children under 13 in connection with our online services, where required we will comply with the Childrens Online Privacy Protection Act (COPPA), including taking additional steps to protect the privacy of such information, including obtaining verifiable consent from the parent or legal guardian of the child before collecting or using the childs PII; notifying parents about what PII is being requested and how that PII will be used and/or shared, such as through this policy limiting the online collection of PII from children to no more than is reasonably necessary to accomplish the purpose of the collection,giving parents a description of and access to the PII we have collected from their children; offering them the opportunity to request that such PII be changed or deleted; offering them an opportunity to prevent any further use or collection of information about their children; and maintaining reasonable procedures to ensure the confidentiality, security and integrity of the personal information collected. We may also need to collect certain information about children and minors in an offline context, such as when a parent or legal guardian of a minor signs up for a membership including the child at a local YMCA, or for a program or camp we offer at one of our locations; and minors visit our facilities without a membership, where we may collect information about them to be able to contact their parent or legal guardian to notify them of an injury or other issues involving the minor.

Links to Other Sites
Users may find other content on our websites that link to the sites and services of other third-parties. We do not control the content or links appearing on these sites. Third-party sites or services, including their content and links, may be constantly changing and may have their own privacy policies and customer service policies. We encourage you to review the privacy policies of any third-party sites or services before providing any of them with your personal information.

If you opt-in to receive information from us, you can change your mind later. If at any time you would like to stop receiving such information or opt out of a feature, you may change your options by contacting [insert contact information]. You should be aware, however, that it is not always possible to completely remove or modify information in our databases and servers, although we will make reasonable efforts to do so upon your request, and we are unable to have your information removed from the records of any third-party who has been provided with your information in accordance with this policy.

Personal Data Access and Accuracy
You may contact The Y with inquiries or complaints regarding the use of information about you. We will use reasonable efforts to grant reasonable requests to access data about the requester. We will also make reasonable requests to correct any incorrect or misleading data about the requester.

YMCA'S take appropriate administrative, technical, and physical measures to safeguard against unauthorized processing of personal information, and against the accidental loss of, or damage to, personal data. However, The Y cannot provide an absolute guarantee of the security of any of our websites or any other site on the Internet.

Consent to Transfer
YMCA websites are operated in the United States. If you are located outside of the United States, please be aware that any information you provide to The Y will be transferred to the United States By using YMCA websites, participating in any YMCA services, and/or providing us with your information, you consent to this transfer.

California Privacy Rights
The California Shine the Light law permits California residents to annually request and obtain information free of charge about what personal information is disclosed to third-parties for direct-marketing purposes in the preceding calendar year. The Y does not distribute your personal information to outside parties for their direct marketing without your consent.

Updating your Personal Information
You can update your personal information by emailing us at [insert contact email] or via a written request mailed to: [insert name, title, and address]. Please do not send Social Security numbers or other sensitive information to us via un-encrypted email.

I understand that in order to complete my two week trial, I must provide the Rappahannock Area YMCA with a credit card or checking account for automatic draft. I understand that if I do not cancel my membership within the two week trial period, my account will be drafted automatically and becomes subject to the standard cancellation policy defined in the membership agreement.