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If my membership dues are paid through Credit Card draft or Electronic Funds Transfer, I understand this is a continuous membership plan. This membership will remain in effect for as long as I maintain current payment. It is my complete understanding that if I wish to terminate my continuous membership plan in any way, I must complete a cancelation form and email it to with at least 10 days’ notice prior to my membership draft date. I also understand my membership will not be terminated until I receive confirmation from the Y stating my membership has been terminated.

I understand it is my responsibility to notify the Riverbrook Regional YMCA of any change in address, bank account information (if utilizing bank draft for payment of dues) credit card information, new number or expiration date (if utilizing credit card for payment of dues). I authorize the Riverbrook Regional YMCA to update my banking and credit card information, in my account, when necessary. I understand that a $25 fee may be charged for all unaccepted credit card or EFT drafts.

I understand the Riverbrook Regional YMCA reserves the right to change fees with 30 days written notice.

I understand that all memberships are non-refundable and non-transferable.

I understand that the Riverbrook Regional YMCA assumes no responsibility for injuries or illnesses which I, or anyone listed on my membership, may sustain as a result of physical condition or resulting from participation in any athletic activities, sports program, the use of any equipment, exercise, or other activities. I expressly acknowledge on behalf of myself, anyone listed on my membership, and my heirs that I assume the risk for any and all injuries and illnesses which may result from our participation in these activities. I hereby release and discharge the Riverbrook Regional YMCA, its agents, servants and employees from any and all claims for injury, illness, death, loss or damage which I, and anyone listed on my membership, may suffer as a result of participation in these activities.

In an emergency, I authorize the Riverbrook Regional Y to administer first aid by trained staff and to obtain emergency medical treatment for myself and anyone listed on this membership. I understand the Wilton Ambulance Corp will be contacted for transportation to the Norwalk Hospital Emergency Room. I accept responsibility for all fees incurred in the care and transportation.

I understand that the Riverbrook Regional YMCA is not responsible for personal property lost or stolen while members and/or program participants are using the Y facilities or on Y premises.

I give my permission to the Riverbrook Regional YMCA to use, without limitation or obligation, photographs, film footage, or tape recordings which may include my, and all listed on this membership, image or voice for promoting or interpreting Y programs.

I understand that by participating in the YMCA Nationwide Membership Program, I , and anyone listed on this membership, 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.

I understand the Riverbrook Regional YMCA conducts regular sex offender screenings on all members, participants, and guests. If a sex offender match occurs, the YMCA reserves the right to cancel membership, end program participation, and remove visitation access.

I acknowledge this Agreement and accept the Membership Policies set forth above, in the program brochure and on the website and, being in accordance with the goals and purposes of the Riverbrook Regional YMCA, hereby apply for membership.

Riverbrook Regional YMCA
404 Danbury Road Wilton, CT 06897    203-762-8384

By clicking below you accept the terms of our membership agreement