Child Permission Form

Parents, please use this form to submit permission for your child to visit a Heart of the Valley YMCA branch. You are signing a waiver and providing medical authorization.
  • Enter your child's first name and last name.
  • Select the branch where your child would like to visit.
  • Please list the names of adults with whom you approve your child attending the YMCA. Your child must have a YMCA membership or be listed on the attending adult membership. PLEASE NOTE: Only adults ages 19 and up who are members of Heart of the Valley YMCA may bring your child to the YMCA.
    Adult First NameAdult Last Name 
  • Please print the parent or legal guardian name.
  • Upload a copy of the Parent/Guardian driver's license.
    Accepted file types: jpg, pdf, png, gif, heic, jpeg, Max. file size: 20 MB.

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