YMCA Group Membership Request

Complete this form to request group membership access or make changes to an existing group.

Organization Name *

Phone * Example: 123-456-7890

Email * Enter a valid email address

Community Center Location *

Hold Ctrl (Windows) or Command (Mac) to select multiple locations on desktop.

Activate New Participants To Your Group Membership:

Provide legal name, date of birth (MM-DD-YYYY), and month to add participants.

Remove Participants From Your Group Membership:

Provide legal name, date of birth (MM-DD-YYYY), and month to remove participants. Note: The YMCA must be notified before the 25th of the month prior to change.

Staff Chaperone Changes:

For unpaid staff accompanying participants at the Y only. Provide legal name, date of birth (MM-DD-YYYY), and add/remove requests.