Parent or Teen?

I am a Teen purchasing the Membership for Myself

YesNo

Since you are under 18, please ensure that your parent or legal guardian is present with you for the billing information and for signing the YMCA of Central Florida Waiver, Release, and Indemnification Agreement, Privacy Policy, Terms & Conditions, and Membership Policies.

I agree and acknowledge that an adult is present with me

Preferred YMCA Family Center:

You have access to all YMCA Family Centers across our six counties

Parent Product

Child Product

Emergency Contact Full Name

Emergency Contact Mobile Phone

Your Relationship to this Individual

TEEN MEMBER's INFORMATION

First name

Last name

Date of Birth

Gender

Your Relationship to this Individual

I need to more Teens to this membership

Additional Teen Member's Information

First name

Last name

Date of Birth

Gender

Your Relationship to this Individual

I need to add one more Teen to this membership

Additional Teen Member's Information

First name

Last name

Date of Birth

Gender

Your Relationship to this Individual

Billing Details

Billing First name

Billing Last name

Billing Email

Billing Phone

Billing Contact Birthdate

Billing Contact Gender

Address Line 1

City

State/Province

Postal Code

Country

Payment Information

Card Number

Code

Cybersource_Hidden_Fields

This section needs to be filled out by your Parent or Legal Guardian

I accept the YMCA of Central Florida's Code of Conduct, Membership Policies, Terms and Conditions, and Privacy Policy.

I acknowledge that all additional members live in the same household and the payment towards this membership is non-refundable.

YMCA of Central Florida Waiver, Release and Indemnification Agreement

I acknowledge that I have read and agree to the YMCA of Central Florida Waiver, Release, and Indemnification Agreement for all Adults and Minors listed above.

Your card will be charged:

Number of Teens