Liability Clause: I, the parent/guardian of the minor child listed on this applications, for ourselves, our heirs, executors and administrators, hereby release, waive, acquit and forever discharge the Boys & Girls Clubs of Wayne County, Inc.
(hereinafter known as BGCWC) and Boys & Girls Clubs of America (hereinafter known as BGCA), their representatives, successors, insurers, assigns or any other person or entity associated with any of the above organizations such as staff, directors or volunteers, from all liability, claims, demands, or causes of action for any and all loss, damage, injury or death and any claim of damages resulting from use of facilities owned or controlled by the above organizations, or participation in activities of said organizations either at or away from the Club. I understand that BGCWC shall not be responsible or legally liable for any bodily injuries or the result thereof incurred and suffered by my child on any property of BGCWC, or while engaged in any activity away from the club, unless such loss or injury results directly from negligence or willful act or any employee of BGCWC acting within the scope of his/her employment.
Medical Consent: I give consent to BGCWC to seek emergency medical treatment for my minor child if I cannot be reached. I consent that my child may be transported and given medical treatment if it becomes needed. I will be responsible for any cost of medical attention and treatment incurred. I give BGCWC consent to use over-the-counter topical ointments, sunscreen and topically applied insect repellant.
School Information: I give consent to BGCWC, Wayne County Public Schools (WCPS) and any private/charter schools to exchange information regarding the minor child listed on this application. The purpose of the exchange is to better help the member be successful in school, in the Boys & Girls Clubs and in life. This release is valid for one year and may be revoked at any time by contacting BGCWC in writing.
Survey/Questionnaires: I give consent for BGCWC to survey my child about his/her Club experiences, behaviors, skills, and attitudes using BGCA’s National Youth Outcome Survey or other instruments such as pre/post testing pertaining to Boys & Girls Clubs programs. Example of programs: Power HOUR, SMART Moves, Triple Play, Healthy Habits, etc.
Technology: As a member of BGCWC, your child will have access to the Internet. While precautions are taken at the Club to secure and protect all members, it is possible s/he may access inappropriate sites. BGCWC has rules and consequences at the Clubs for such behavior; however, we will not be responsible for the consequences of such access.
Bring Your Own Device (BYOD): We allow members to use the Wi-Fi in our facility. The same precautions on our wired network are used to secure and protect the children while using the Wi-Fi. However, if a child is not on the Wi-Fi those precautions are not in effect. We cannot control what your child does on his/her data plan, if applicable. If your child is seen accessing inappropriate content, your child will be required to turn their device into the front desk and will remain there till a parent/guardian picks up the child.
Media Release: I give consent for my child’s photo, video, graphic depiction, or likeness used in media published in BGCWC advertisements, publications, press releases, or used in conjunctions with partner agencies
Mentoring: I give consent to BGCWC to provide mentor programs/opportunities via BGCA if available.
Privacy: I give consent to BGCWC to share information about my child with BGCA and other grant funders, for research purposes to evaluate the programs’ effectiveness. Information that will be disclosed to BGCA may include information provided on this membership application form, information proved by my child’s school and/or school district, surveys or questionnaires, and other data collected by BGCWC. All information collected or provided to BGCA and other grant funders will be kept confidential.
Miscellaneous: I understand the Club is not, nor does it claim to be, a licensed day care center. I understand membership st ends December 31 of each year. Parents and Club members are responsible for their own transportation to and from the Club. I understand the Boys & Girls Clubs is not responsible for lost or stolen items.