NEW MEMBER CONSENT
I promise to take care of my Club and property. If at any time I am asked to return my card, I understand no dues will be returned to me.
As a guardian of the child named on this application (the applicant), I hereby give my consent for him/her to become a member of the Boys & Girls Club of Nampa. I understand that by signing this document, I am agreeing to the terms and provisions of the document. The following is a summary that is not intended to cover all policies and provisions in the document. Guardians should read in full all documents before signing the Membership Form.
• The Club is not responsible for injuries and accidents that may occur at The Club or during activities outside The Club.
• The Club may provide medical attention to injured Club Members and take them to an emergency facility if needed.
• The Club is not responsible for how or when Club Members arrive or leave The Club.
• Consent is given for publication of photographs or video of, and creative outputs by the applicant.
• Consent is given for participation in surveys given by the applicant for the purpose of Club promotion.
• Consent is given for the applicant to use the computers and access the Internet.
• Membership is granted, and acceptance with all policies and provisions in the Membership Application.
• It is the policy of our program that no person be excluded from participation of the grounds of race, creed, color, sex, religion, national origin, income or handicapping condition.
Parents and/or guardians also authorize the Club to obtain information (including but not limited to: report cards, emergency contact information, etc.) from the child’s school as necessary.
Respiratory Illness Screening Questionnaire
Screening for signs, symptoms, and risk factors for COVID-19 illness is being done at this facility for the protection of the children and staff here, your family, and our community. Thank you for your understanding of our need to take this added precaution. It is an important element of complying with Governor Little’s order for preventing community spread of COVID-19 illness.
We are screening all employees, contractors, children, parents/guardians for the following:
1. Have you had any signs or symptoms of a respiratory infection?· Fever
· Shortness of breath
2. In the last 14 days, have you had contact with:
· Someone with a confirmed diagnosis of COVID-19
· Someone under investigation for COVID-19
3. Have you had any signs or symptoms of a gastrointestinal illness?
If any person fails symptom screening by answering ‘yes’ to any element of questions 1, 2, or 3, they will not be permitted to enter our facility.
· You will be contacted if your child becomes symptomatic while here. Our expectation is that you will come and pick up your child and all siblings promptly. Your child will be resting in an area away from other children while waiting for you to arrive.
· Any employee or contractor that becomes symptomatic while they are in the facility will be asked to leave promptly.
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
Boys & Girls Clubs of Nampa has put in place preventative measures to reduce the spread of COVID-19; however, the Club cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Club could increase your risk and your child(ren)’s risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Club and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families.
I further acknowledge my own responsibility in reducing the risk of spreading COVID-19 to others. As such, by signing below, I agree not to come to the Club, or bring my child(ren) to the Club, if I or anyone in my household has a cough, fever, or is having difficulty breathing.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Club or participation in Club programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after partcipation in any Club program.