FALL in Love With the Y! – FREE 2-Week Membership Application Form

I agree to share the information I've entered in this form with the Bangor Region YMCA, and I agree to be contacted by the Bangor Region YMCA using any of the contact information I've provided.

In consideration of gaining membership or being allowed to participate in the activities and programs of The Bangor Region
YMCA and to use its facilities, equipment, and machinery in addition to the payment of any fees or charge, I do hereby waive,
release, and forever discharge The Bangor Region YMCA and its officers, agents, employees, representatives, executors, and all
others from any and all responsibilities or liability for injuries or damage resulting from my participation in any activities or my
use of equipment or machinery in the above mentioned facilities or arising out of my participation in any activities at said facility.
I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any
injuring or damage to myself, including those caused by negligent act or omission of any of those mentioned or others, acting on
their behalf or in any way arising out of or connected with my participation in any activities of The Bangor Region YMCA or the
use of any equipment at The Bangor Region YMCA. I agree to adhere to all policies set by The Bangor Region YMCA as written
in The Bangor Region YMCA code of conduct. I give permission to The Bangor Region YMCA to use photographs and or videos
of myself and above listed family members for the promotion, public relations, records, or other legitimate purposes. I fully
understand that there is no monetary payment to be made to me or anyone else.

The Bangor Region YMCA considers it of great importance to provide a safe and threat-free environment. For
this reason, The Bangor Region YMCA monitors the sexual offender registry. Persons on the list will not be eligible for YMCA
membership, program participation, volunteer or employment opportunities with this YMCA.