Membership Hold Request Form - South Shore YMCA

South Shore YMCA Membership Hold Request

Submit this form if you wish to place your South Shore YMCA membership and payments on hold for up to 4 months. Our team will contact you to confirm your request within 1-3 business days.

Name*
First Last
YMCA Branch*
Today's Date*
MM slash DD slash YYYY
Requested "Hold Until" Month/Year*
When would you like to resume your monthly membership? Note, holds are typically accepted for 1-4 months.
Member ID# / Member Tag #
Help us identify you in our system with your Y tag # or your membership ID#.
Date of Birth*
Month
Day
Year
Home/Primary Phone*
Mobile Phone
Email*
Monthly Draft Date*
The day of the month that your membership dues are drafted from your bank or credit card account. Typically 1st or 15th of the month.
- 1st of the Month (first)
- 15th of the Month (fifteenth)
- I don't know
- This is an annual membership - paid in full
Primary Reason for Hold*
Choose one. Please note that Medical, Military and Temporary Residence holds will require additional documentation.
Comments / Questions
Would you like to learn how you can DONATE your membership dues?*
Not ready to return to the Y, but still want to support the great work we do for the community? Our team can easily convert your monthly membership dues into a tax-deductible donation. Learn more and stay with us!
- Yes, contact me
- No, please place me on hold