Youth Guest Pass (Ages 10-17)

We hope that  your child’s visit with us as a guest is an enjoyable one. Before your child utilizes our facility, we ask that  the parent/person having legal custody/guardianship read our guest guidelines below and sign the waiver statement provided on this form.

  • All guests  under the age of 18 will provide a waiver signed by their parent/guardian and this will be verified by a Y staff member.
  • Waiver will be kept on file for 12 months, at which time a new waiver will need to be signed.
  • Waiver may be completed online and signed digitally, or printed and signed.
  • Youth guests  will be expected  to follow the HRYMCA Code of Conduct, comply with all HRYMCA rules and policies, and follow the specific rules for individual departments.

Guest Pass Fees:

  • $20 per family – up to 2 adults and their dependent children
  • $6 per individual youth aged 10-17

Youth Guest Information

Youth Guest

Youth Name*  
Gender Date of Birth*


Name* Email*
Phone* Phone 2
Address* City*
State* Zip*
Emergency Contact Name* Emergency Contact Phone*

Liability Waiver Statement

I certify that I am at least 18 years of age and I have read, understand, and voluntarily accept the terms of this Agreement and further agree that no oral representations, statements or inducement apart from the foregoing Agreement have been made.

I certify that I am the parent and/or legal guardian of (the minor) who is currently under the age of 18.

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 use of YMCA facilities, and from any liability for other claims, including loss of property, to the fullest extent of the law.

By checking this box and retyping my name below, I am electronically signing this form.

Parent/Guardian Name*