Teen Membership


Demographic Information

As a non-profit agency, the YMCA relies on various federal and local funding Sources that require the following information as part of the grant application process. All information is confidential.

AGREEMENT: Liability Waiver & Code of Conduct

I, _________________________________________________ (insert name) understand and agree on behalf of myself, to abide by the following policies and Procedures in consideration for my membership to the YMCA.

The YMCA reserves the right to deny access, reject or cancel any application or membership of any person. This includes, but is not limited to, any person known to have been accused or convicted of any crime involving child abuse, or sexual abuse or is a registered sex offender. By signing this form, you certify that neither you nor anyone on your membership has been accused or convicted of a criminal offense listed above. I understand that the Greater Waterbury YMCA employees, agents, and assigns, have the right to videotape or photograph me and use my picture, voice, quotes, silhouette and other reproductions of my physical likeness (as the same may appear in any still camera photography and/or motion picture film/video), in and in connection with the advertising, promoting and communications for YMCA purposes only. I understand that while exercise is instrumental to maintaining good health, use of the facilities at the YMCA incurs some potential risk. In consideration for being allowed to participate in activities and to use the equipment and facilities at the YMCA, I assume the risk of all such usage and further agree to hold harmless the YMCA and its staff members from any and all claim suits, losses, or related causes of action for damages, including but not limited to, such claims that may result from my injury or death, accidental or otherwise, during, or arising in any way from exercising or using the facilities at the YMCA. I understand the YMCA is not responsible for lost or stolen items. I further understand the YMCA has the right to revise policies and procedures without notice.

Code of Conduct:
 Members shall always act appropriately when in the YMCA’s facility or participating in its programs.
 Members are responsible for their personal comfort and safety.
 Members should report inappropriate behavior to a staff person or the Building Supervisor on duty.
 Members shall not cause disruption to membership or programs.
 Members and/or guests shall not use the premises and/or services of the Greater Waterbury YMCA for any form of compensation.
 Members and/or guests shall identify themselves to staff when asked.

The Greater Waterbury YMCA provides information to youth about proper boundaries between adults and their peers. There are a few steps youth can take if an opposing party tries to break these rules or violate their boundaries. Through our policy, we provide parents with information on how to protect their children from abuse. The YMCA’s policies related to staff and youth interaction and between their peers include how to recognize warning signs of abuse and how to respond to their peers if they suspect abuse. The YMCA provides several ways to report concerns. They may directly speak to the Youth & Teen Development Director Edna Walton at (203)754- 9622 EXT 124. They also may contact Sr. Director of Operations at mtedesco@waterburyymca.org or at (203) 754-9622 EXT 157. They may talk privately with them or to any other staff directly or may anonymously express their concerns by phone or by depositing a note in our suggestion box. We have established procedures for responding to any concern.

I have read and understand the liability waiver and code of conduct.


Greater Waterbury YMCA Teen Rules

An adult must always accompany any member under the age of 12. Teen Hours (hours are subject to change)
     Monday – Friday: 2:00 pm - 9:00 pm
     Saturday: 7:00 am - 4:00 pm
     Sunday:  7:30 am - 2:00 pm
1. Teen night is $5 for non-member teens on Fridays ages 13-17
2. If there is no school there is no Teen Night
3. During the school year teen night doors open at 6:00 pm and close at 7:30 pm
**School Age/High School students are not allowed in the building during school hours unless the school is not in session.

Fitness Center Rules
1. Must be 13 years of age to use the fitness center; however, anyone 13-14 yrs. of age MUST have an orientation before using the equipment.
2. Must wear a mask if lifting weights, but if on the cardio side mask is not required.
3. 12 years of age or younger may not use the fitness center under any circumstances.
4. Teen members may resume using the Wellness Center from 11:30am to close.
5. Proper attire is required to use the Wellness Center such as workout clothes and sneakers. Sandals, Boots, croc, khakis, cargo pants, cargo shorts and jeans are not allowed.
6. Cell phone use is not permitted in the Wellness Center
7. The track above the Wellness Center has designated directions and must be followed on the days designated.
8. All Wellness Center equipment must be wiped after use.
9. Belongings should be placed in a locker with a lock to avoid items lost or stolen.

Pool Rules
1. Children under the age of 12 must always have an adult with them in the pool area.
2. An adult must always accompany children 8 yrs. and under IN the water.
3. Must also have the proper attire including a bathing suit must be used.
4. Pool Schedules are available at the Front Desk.

Gymnasium Policies
1. Street shoes are not permitted on the gym floor. Members are advised to bring extra sneakers to participate in activities.
2. Proper sportsmanship is expected when engaging in pick-up and formal league play.
3. No foul or obscene language will be tolerated.
4. Food or drinks are NOT allowed in the gymnasium. (Water ONLY)
5. Have respect for all reserved gym program usage and do not delay or disrupt the programs.
6. The YMCA recommends leaving valuables at home.
7.No hanging on the rims and/or nets.
8. Gym schedules are located at the front desk.
9. Appropriate attire, including shirts and shorts must always be worn.

Guest Policy
1. Teen and youth members are not allowed to bring in guests.
2. Even if the teen is 18 years old they are not allowed to bring guests unless they switch to a college or young adult membership.

Swipe Card Policy
1. If a teen member forgets their card, they will be allowed in once without it. However, the next time they forget it, they will be asked to purchase a new one. If they cannot, they will be asked to leave. A new card is $5, and this applies to lost OR stolen cards. The YMCA does have a free app called "Daxko," which can be downloaded and used as a scan card.

Minor Participant Waiver, Release, Indemnificationof All Claims & Covenant Not to Sue


Assumption of Risk
I, in my legal capacity as parent/guardian of the minor named below (“Minor”), acknowledge and agree that any use of
Greater Waterbury YMCA
facilities, services, equipment, and premises (“Facilities”) and any participation in
Greater Waterbury YMCA programs and activities (“Programs”) comes with inherent risks including, but in no way limited to (1) moderate and severe personal injury, (2) property damage, (3) disability, (4) death, and (5) sickness or disease. I voluntarily, for myself and minor, accept and assume full responsibility for these risks as well as any and all other risks of the use of Facilities and participation in Programs. I agree that I have full knowledge of the nature and extent of all such risks and am not relying on all such risks being described in this document.

Waiver, Release, Indemnification & Covenant Not to Sue
In consideration of Minor’s use of facilities and participation in Programs I, in my legal capacity as parent/guardian of Minor, agree on behalf of myself and Minor that
GREATER WATERBURY YMCA, its officers, directors, agents, employees, volunteers, insurers, and representatives (“Releasees”) will not be liable for any personal injury, property damage, disability, death, sickness, or disease incurred by Minor, however occurring including, but not limited to, the negligence of releasees. I understand that Minor and I will be solely responsible for any loss or damage, including personal injury, property damage, disability, death, sickness, or disease sustained from the use of Facilities and participation in Programs.

I further agree, in my legal capacity as the parent/guardian of Minor, on behalf of Minor, myself, and any and all legal successors and proxies, to release and
HEREBY DO RELEASE, WAIVE AND COVENANT NOT TO SUE Releasees from any causes of action, claims, suits, liabilities, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which Minor, myself, and any and all legal successors and proxies may have, now or in the future, against releases on account of personal injury, property damage, disability, death, sickness, disease or accident of any kind, arising out of or in any way related to the use of Facilities or participation in Programs, whether that participation is supervised or unsupervised, however, the injury or damage occurs, including, but not limited to, the negligence of Releasees.

In further consideration of the use of Facilities and participation in Programs, I, in my legal capacity as parent/guardian of Minor, agree on behalf of myself and the minor to INDEMNIFY AND HOLD HARMLESS releasees from any and all causes of action, claims, demands, losses, suits, liabilities, or costs of any nature whatsoever, including claims of negligence, arising out of or in any way related to the use of Facilities and participation in Programs.