Apply for an Open Doors Scholarship in five easy steps!


1. Applicant Information
Mailing Address

Emergency Contact Information
Emergency Contact Name

2. All Additional Persons Living in this Household
Yes Name DOB Gender

3. I Am Applying For


For Child Care and Camp Applicants Only
Parent/Guardian #1
Parent/Guardian #2

4. Please Provide the Following Documents

Federal Taxes


Current Income


Document Upload

Maximum 3 files.
64 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Maximum 3 files.
64 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.


Tell Us More

Use this space to include any additional information or extenuating circumstances that were not included on this application.

5. Signature


Every member over the age of 12 must have his/her photo on file with the YMCA and must show their valid YMCA access card to enter the YMCA facility. If a member has forgotten their card they must show a photo ID to be manually checked in or be accompanied by an adult 18 years of age and over. A Release & Waiver of Liability and Indemnity Agreement must be signed for all Facility Memberships.

Nationwide Membership:

By participating in the YMCA Nationwide Membership Program (the “Program”), I agree that Channel Islands YMCA may share my YMCA membership information (e.g., [name, address, telephone number, e-mail address, date of birth and membership status]) with 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 (collectively, “Y-USA”) for purposes of my participation in the Program.

Changes in Membership:
Any cancellations, billing information updates, payment or membership changes require written notification 30 days prior to your next draft date. All provisions of the Membership Agreement remain valid and in force regardless of payment, billing or membership changes. If a membership is canceled during a program, program member rates will be charged for said program. 

The YMCA reserves the right to change membership fees. You will be notified 30 days in advance if fees are scheduled to change. It is the responsibility of the member to keep all payments to the YMCA current. 

If your YMCA account balance becomes more than 60 days overdue, your account will be handed over to a 3rd party account management company.

Photographic and Video Release:

In exchange for good and valuable consideration, the adequacy of which is hereby acknowledged, I hereby give Channel Islands YMCA, its volunteers, employees and any other person and entity acting with its permission the right to take, copyright, use, and publish any photographs or video of me or my child/children for the purpose of any YMCA advertising, promotion, or other purpose consistent with the YMCA mission. 
I agree that any such photograph or video is the property of the Channel Islands YMCA, and I hereby waive all rights thereto. I further waive any right to inspect or approve any printed or electronic material that may be used in conjunction with the photographs or video, or to approve the use to which the photographs or video may be applied.

Identification and SOR Screening:

Membership at any Channel Islands YMCA branch requires each individual over the age of 18 to provide at least one legal picture identification at the time of enrollment. Acceptable means of identification are: Drivers License, State Identification Card, Passport, School Identification Card, or Military Identification. At time of membership enrollment, and as needed, a photo of each individual will be captured and added to the membership record. 

The 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. 

The YMCA reserves the right to deny access or membership to any person who has been convicted of any crime involving sexual abuse, is or has been a registered sex offender. The YMCA reserves the right to conduct background checks on current and prospective members.



This Application May Be Reviewed Every Year.

Signature of person completing the form


Note that incomplete applications, or applications submitted without proper supporting documentation, cannot be reviewed.

Payment plans are available.

All records are kept confidential.

Applications take up to two weeks to process.

Scholarship awards expire 30 days from the date of this award notification.  If your scholarship is not accepted within that time you will need to reapply.  Once approved, your scholarship/discounted rate is valid from the date of approval to 12 months thereafter.