The LATE NIGHT program is offered three times a month at the South YMCA.

IMPORTANT: The online form must be submitted by 3:00PM on the Friday BEFORE the Saturday Late Night event that the participant is wanting to attend. If you do not submit the online form by 3:00PM on Friday, you will be asked to fill out or present the printed form (found HERE), along with a valid school ID upon arrival to the YMCA branch.

Please fill out all required fields of the Late Night Participant Form and Waiver From.

GREATER WICHITA YMCA

Late Night Participant/Waiver Form

Branch
Membership Status
Gender (select one)
Address
Race (choose one)

Late Night Participant Guidelines

  1. Late Night is a FREE program open to YMCA members and non-members who are in 9th-12th grade.
  2. All participants must have a valid State Issued ID/Driver’s License or current School ID in order to attend Late Night.
  3. All participants must have this form completed prior to admittance into Late Night.
  4. All bags and purses will be searched prior to entering the program to keep unauthorized items and dangerous weapons out of the facility. Items such as drugs, drug paraphernalia, and weapons will be confiscated and the police and/or parents/guardians contacted. Access to Late Night will be denied and a suspension from the program and/or the YMCA will be determined by the Branch Director.
  5. All bags, purses and phones will be secured according to the branch’s procedure. Please leave all valuables at home as the YMCA and Late Night staff is not responsible for lost or stolen items, checked in or not.
  6. Appropriate clothing (athletic and swimsuits) must be worn to participate in Late Night programs. Participants who do not abide by the dress code will be asked to leave for the night.
  7. 7. Late Night check in starts at 7:30 pm ends at 8:00 pm. All activities will end 10 min. before closing time (10:00 pm). Participants are encouraged to help clean up. Participants must be picked up no later than 10:15 pm.
  8. Participants who check out of Late Night before the program is over will not be allowed to re-enter and must immediately leave the YMCA property. If being picked up, participants should wait inside the YMCA for their ride to arrive as participants will not be permitted to wait unsupervised outside.
  9. All facility rules must be followed in addition to the Late Night rules: Be Safe, Be Respectful and Do the Right Thing. Respect the Staff, Respect One Another and Respect the Building and Equipment.
  10. Violation of rules in Late Night will result in suspension from all YMCA facilities and programs.
Sign above

_______________________________________________________

Release & Waiver of Liability & Indemnity Agreement

In consideration for being permitted to enter or use the premises, facilities or equipment of the Greater Wichita YMCA (“YMCA”), receive any of the services furnished by the YMCA, or participate in any of the programs offered by the YMCA, without respect to location, the undersigned, for himself or herself and his or her children under the age of eighteen (18) (collectively, “Minors”), and their respective personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or will immediately upon entering, receiving or participating, inspect and carefully consider such premises, facilities, equipment, services or affiliated programs. It is further warranted by the undersigned that any such entry or use of the premises, facilities or equipment of the YMCA, receipt of services furnished by the YMCA or participation in programs offered by the YMCA constitutes an acknowledgement by the undersigned that such premises, facilities, equipment, services and programs have been inspected and carefully considered by the undersigned and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use, receipt or participation by the undersigned and the Minors.

  1. THE UNDERSIGNED, ON BEHALF OF HIMSELF OR HERSELF AND THE MINORS, HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the YMCA, its directors, officers, employees, and agents (hereinafter referred to as “Releasees”) from any and all liability to the undersigned, the Minors or their respective personal representatives, assigns, heirs, or next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned or any of the Minors, whether caused by the negligence of the Releasees or otherwise while the undersigned or any of the Minors is in, upon, or about the premises of the YMCA, while using any facilities or equipment thereon, while receiving any service furnished by the YMCA or while participating in any program offered by the YMCA, without respect to location.
  2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned or any of the Minors in, upon, or about the premises of the YMCA the undersigned or any of the Minors observing or using any facilities or equipment of the YMCA, the undersigned or any of the Minors receiving any service furnished by the YMCA or the undersigned or any of the Minors participating in any program offered by the YMCA whether caused by the negligence of the Releases or otherwise.
  3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to the negligence of Releases or otherwise while the undersigned or any of the Minors is in, about, or upon the premises of the YMCA, while the undersigned or any of the Minors is using the premises or any facilities or equipment thereon, while the undersigned or any of the Minors is receiving services furnished by the YMCA or while the undersigned or any of the Minors is participating in any program offered by the YMCA.
  4. THE UNDERSIGNED GIVES THE YMCA PERMISSION to conduct a sex offender registry (SOR) check on him or her, each member, visitor, and guest; provided, however, the YMCA shall have no obligation to perform any such check and the YMCA shall have no liability to the undersigned or anyone else for conducting or failing to conduct any such check.

The undersigned further expressly agrees that this Release and Waiver of Liability and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the law of the State of Kansas and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect to the greatest extent permitted by law.

The undersigned has read, understands the terms of and voluntarily signs the Release and Waiver of Liability and Indemnity Agreement, and further agrees that no oral representations, statements, or inducement apart from those set forth herein have been made by the YMCA to the undersigned.

The undersigned has signed this Release and Waiver of Liability and Indemnity Agreement intending to be legally bound by the terms hereof and for the purpose of the inducing the YMCA to allow the undersigned and the Minors to enter and use the premises, facilities, and equipment of the YMCA, receive services furnished by the YMCA and participate in programs offered by the YMCA. The undersigned acknowledges and agrees that this Release and Waiver of Liability and Indemnity Agreement is a material inducement for the YMCA’s authorization for such entry, use, receipt, and participation.

CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.