Membership Form for Staff and dependents

Staff Membership Form

Eligible family members/dependents of YMCA of Niagara staff can also use this form

We are delighted to welcome employees (and their family) back to our YMCA! Members of staff can extend their YMCA membership to their eligible family members and/or dependents.

Complete and submit the form below and a YMCA Membership Services representative will be in touch with you about your new membership or to help you reactivate an existing membership.

Should you need any assistance with your registration, please e-mail customer service.

Please note:

Fields marked with a * are compulsory
If you are not a YMCA of Niagara employee, or have not been referred by one, please complete and submit the Membership Join Form

What branch would you like to join? *

Are you registering as an Individual or a Family? *

Individual
Family

Personal Information

Primary member *

First

Last

Please enter your name and not the name of the referring YMCA of Niagara employee

Gender *

Male
Female
Other

Date of birth *

Format: Date/Month/Year

Home address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Please note: For 'Family' memberships, all individuals being enrolled must be from the same household.

Contact number *

Contact e-mail *

Medical concerns or allergies, if any

In case of emergency, contact *

First

Last

Their contact number *

Membership and Payment

Please select your membership product(s), reactivation/start date, and confirm your payment method. Customer service may be in touch to confirm or update payment information.

Please confirm your membership status here at the YMCA of Niagara *

I am a returning YMCA member
I am a new YMCA member

When would you like your membership to take effect? *

Payor *

First

Last

Date of birth *

Format: Date/Month/Year

Payment method *

Please note: Customer service may be in touch regarding your payment information.

Billing acknowledgement *

I understand my first payment is due/will be charged on my reactivation or start date. I understand the amount will be pro-rated to reflect the number of days from the reactivation or start date until my first bi-weekly payment date. I also understand that I will receive confirmation once my membership is set up, including my payment amount.

Staff Membership Form

Eligible family members/dependents of YMCA of Niagara staff can also use this form

Personal Information

Membership and Payment

Family Members

Did you know?

Declaration and Acknowledgement