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    Freeze Membership Form

    Any member wishing to freeze their membership account may do so once every twelve months for up to four consecutive months. All freezes will be in 30 day increments and will be subject to a freeze fee. Please be advised that you must fill out this freeze form and submit it at least 5 business days prior to your draft date. (e.g. 25th or 10th of the month) No retroactive freezes are permitted. Medical freezes are of no charge and can be extended for any period of time. Doctor's note required.

    Freeze Rates
    Family $15/month
    Adult Couple $12/month
    Active Older Adult Couple $12/month
    Adult $10/month
    Active Older Adult $10/month
    Young Adult $10/month
    Teen $5/month
    Youth $5/month
    Special Needs $5/month

    I understand that I can freeze my account up to 4 months per calendar year at the specified rate according to my membership account type.

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    *Today's Date:
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    *Name:
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    *Address:
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    *City, State, Zip:
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    *Daytime Phone:
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    *Email Address:
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    Monthly Draft
    Members will have their account drafted at the appropriate reduced monthly price on the usual draft date of either the 1st or 15th.
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    Annual Membership
    Annual members will need to pay the appropriate reduced monthly price for the duration of the requested freeze. Payment will be collected at the end of the freeze period.
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    Medical Freeze
    Members who need to freeze their accounts due to a medical situation must provide a Doctor's note along with the completed freeze form.
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    Please provide the freeze start date and the number of months being requested (30 day increments only.)
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    *Start Date:
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    *# of months:
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    Your draft amount will automatically begin again after this time period.
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    By hitting the submit button, you are agreeing to the above terms.
CENTRAL BUCKS FAMILY YMCA | 2500 Lower State Road | Doylestown, PA | 215.348.8131

MISSION: Central Bucks Family YMCA is a charitable non-profit organization whose purpose is to improve the quality of community life. The Y strengthens the spirit, mind and body of its members. We build character by promoting the values of caring, respect, honesty and responsibility.

The Y is committed to providing programs that build a healthy spirit, mind and body for all. We make every effort to ensure that no one is turned away due to inability to pay. Click to read more about our financial assistance.

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