Youth and Teen May Center Membership

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Please select one:*	This is my first time purchasing a May Center Elementary/Teen Membership. I am an existing Elementary/Teen Member and want to renew my membership.
If renewing, enter May Center membership card ID number: Your Membership ID number is 10 digits long and appears at the bottom of your Membership ID Card. See an example Renewal transactions are not considered final until approved by Membership Management.
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Does your child have any chronic medical conditions or disabilities?:*	Yes  No
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Please provide any personal information of which we should be aware:
Has your child recently experienced breathing problems, shortness of breath, coughing during or after exercise or asthma?:*	Yes  No
In the last six months, has your child experienced any muscular pain while exercising or joint pain?:*	Yes  No
If yes, please specify:
Has your child on one or more occasions lost consciousness or fallen over as a result of dizziness?:*	Yes  No
Are you aware, through your own experience or a doctor's advice, of any other physical reason that would prohibit your child from exercising without medical supervision?:*	Yes  No
If you answered "yes" to any of the above questions, a medical clearance will be required from a physician prior to participating in physical activity at the 92nd Street Y.
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I hereby apply for an Elementary/Teen membership to 92Y May Center for Health, Fitness & Sport with the understanding that all members must adhere to the following policies and Code of conduct:

Elementary & Teen Membership Policies
General

• No refunds will be issued on an annual elementary/teen membership.
• The membership card is NOT TRANSFERABLE.
• Elementary and Teen memberships are subject to limited hours and detailed in the Elementary & Teen Activity Schedule. Hours are subject to change and may be adjusted for special events and holidays.
• Memberships do not include use of racquetball courts or participation in group activity classes.
• Medical freezes are available with written documentation from parent and physician.
• Convenience freezes (maximum of 6 months) will be offered with written documentation from parent. The fee for this service is $10 per month.
• Guest Policy: All guests must be accompanied by a member, provide photo ID and complete a guest waiver; limit two guests per visit.
• Valuables should be secured with a lock in a daily locker. Locks are available for purchase or rental at the Front Desk.
• Orientations are required prior to using all cardio, strength & fitness conditioning equipment. Orientations may be scheduled by calling 212.415.5729.
• Appropriate attire is required to play basketball and utilize the cardio and strength training areas. Cut-offs, street clothes, flip flops, sandals, and street shoes are not permitted.

Pool

• Children must be able to swim 25 yards unassisted in order to swim unaccompanied by an adult. Swim tests (and/or private lessons) may be scheduled by calling 212.415.5718.
• Adult supervision is suggested for elementary members while in the locker rooms.
• Bathing caps are required.
• Goggles are suggested.
• Diving is not permitted; nor is the use of the starting blocks.
• Adult members wishing to swim at the same time as their Elementary or Teen child(ren) must swim in the lanes allocated for Adult Lap Swim.
• Family Swim is held on Saturdays and Sundays from 1-3 pm. Adult May Center members may bring children under the age of 6 at no charge; children over 7 years require a membership or guest pass. Non-member adults may purchase guest passes at the third floor desk.
• No jeans or cut-off shorts may be worn in the pool.
• Special events such as swim meets pre-empt scheduled activities; please check postings for schedule changes.

Code of Conduct: It is expected all participants of the Elementary & Teen membership follow good  sportsmanlike conduct at all times while in the facility.  Fighting, swearing, & disrespectful behavior will not  be tolerated anywhere on premise.  In the event that the behavior policy is violated by the member or his/her  guest; the member may be suspended or have his/her membership terminated.  The guest will be asked to  leave the May Center immediately (without refund of guest fee).

INDEMNIFICATION: I, the undersigned minor, understand the nature of the activities in which I am    participating, and believe myself to be in good health and proper physical condition to participate in such  activity. I release, discharge,  covenant not to sue, and agree to indemnify and hold harmless 92nd Street Y  (“92Y”) and 92Y’s agents,  officers, directors, employees, and instructors from any and all claims, liabilities,  demands, losses or  damages (including attorneys’ fees and disbursements) incurred as a result of any  accident, injury, and/or  physical condition except to the extent that such accident, injury, and/or physical  condition is caused by or  results from the gross negligence or willful misconduct of 92Y or its agents,  officers, directors, employees  or instructors.

CONSENT FOR EMERGENCY MEDICAL TREATMENT: I authorize 92Y’s May Center and its  designated representatives to consent, on my behalf, to any medical  care or treatment to be rendered in the  event of an emergency.  I agree to be responsible for any and all  necessary charges incurred as a result  of, and in connection with, such emergency care.

PHOTO/VIDEO RELEASE: I give permission for my image (e.g. photograph, video), and/or a sound    recording, to be used by 92Y and  those acting with the authority and permission of 92Y, in promotional and  media materials. These materials  include, but are not limited to, brochures, websites and television/radio  coverage. I waive any right that I may  have to inspect or approve the finished product or products or the  advertising copy or printed matter that  may be used in connection therewith or the use to which it may be applied.

I release, discharge and agree to hold harmless 92Y, its legal representatives or assigns, and all persons acting under its permission or authority or those for whom it is acting, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said picture, production of any video footage or voice recording, or in any subsequent processing thereof, as well as any publication thereof.

 Annual Rates

 Added benefits of Elementary & Teen memberships:

• Discounts on a wide variety of 92nd Street Y activities and programs.
• Discounted teen fitness classes; many of which are available for only $92.

Find out more about adult fitness memberships.