Open Doors

Application Type(Required)

New Application
Renewal Application

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Gender(Required)

Male
Female
Unspecified

Membership Category (please select one)(Required)

Family
Adult
Youth
Senior
Senior Family
College Student

Additional Members of your Household

Name

First Last

Relationship

Gender

Male
Female
Unspecified

Age

Name

First Last

Relationship

Gender

Male
Female
Unspecified

Age

Name

First Last

Relationship

Gender

Male
Female
Unspecified

Age

Name

First Last

Relationship

Gender

Male
Female
Unspecified

Age

Name

First Last

Relationship

Gender

Male
Female
Unspecified

Age

Income Information

Employer

Gross Monthly Income (before taxes)

Length of Employment

Position

Part Time or Full Time (please select one)

Full Time
Part Time

Employer

Gross Monthly Income (before taxes)

Length of Employment

Position

Part Time or Full Time (please select one)

Full Time
Part Time

Employer

Gross Monthly Income (before taxes)

Length of Employment

Position

Part Time or Full Time (please select one)

Full Time
Part Time

Attach copies of your most recent Federal Tax Returns or your VNF from the IRS(Required)

Max. file size: 2 MB.

The Member Experience Director may contact you for additional information if needed or an appointment may need to be scheduled.

Statement of Need(Required)

Please explain how an Open Doors membership will positively affect you and or your household. Please note that if not completed the application will not be processed.

Consent(Required)

I verify that the above information is accurate.

I verify that the above information is accurate. I understand that I will inform the YMCA of any changes to my income. I understand that my membership can be terminated if false information is presented. I understand that my Open Doors Membership will need to be renewed every year or when requested by the YMCA.

The YMCA requires that individuals reapply when their
membership expires (one full year from approval date)
or when requested to keep the information on their
application updated. The ability of the YMCA to respond
to requests for assistance is dependent upon the
success of fundraising projects and current operating
financial situation. Open Doors rarely covers 100% of
the total membership fee. Your fees are subject to
increase when you reapply. If you do not reapply
annualy your discount will be removed and you will be
charged full rate.

Name

This field is for validation purposes and should be left unchanged.

Kishwaukee Family YMCA

Open Doors Membership Program

How to Apply

Open Doors Membership Application

Additional Members of your Household

Income Information