If you have multiple children in need of child care, please complete a separate form for each child.
Youth Medical Information
Pick Up Information: (Two people authorized to pick up member-OTHER THAN PARENT)
Informed Consent and Acknowledgement
I understand and agree that my child (or ward) must be picked up by closing time or a fee will be charged which must be paid before my child (or ward) can return to the Club.
I understand and agree that BGCHC has an open door policy and cannot be responsible for my child (or ward)leaving the Club without permission. I understand that all members are free to come and go from the Club at their leisure.
I understand and agree that BGCHC does not refund membership fees and that my child (or ward) must obey all rules (Code of Conduct). I further understand that behavioral problems that cannot be solved can result in my child (or ward) being suspended from BGCHC without a monetary refund.
It is expressly understood and agreed that BGCHC shall not be responsible or legally liable for any losses of personal property, for any bodily injuries, or the results thereof, incurred and suffered by the applicant on any property of the BGCHC or in connection with any activities of any of its Units, or while engaged in any of the BGCHC’s activities away from the Club.
Internet Usage Agreement: The opportunity to use Club’s computers is based upon clear guidelines and agreements: (1) always be respectful of others, (2) never give out personal information over the computer, (3) always remember you are responsible for what you do online, (4) always follow the computer lab supervisor’s instructions, (5) never agree to meet in person with anyone you meet online and (6) never visit ‘off-limits’ web sites. Failure to uphold these agreements will result in revocation of the member’s online privileges.
Code of Conduct Play Fairly and Be Honest Be Respectful of Boys & Girls Club Staff Say Only Good Things About Others Resolve Disagreements in a Positive Way Be Respectful Of Other Members and Their Property Take Care of Your Boys & Girls Club Facility and Equipment Avoid Use of Improper Language Remove Hats Before Entering Building Applaud The Efforts of Others Run Outside Only Participate Only In Program Areas Open To Your Age Group Listen During Assemblies Dress Appropriately At All Times Smoking, Drugs, Alcohol and Other Drugs and Weapons Are Strictly Prohibited Stealing will not be Tolerated!
Virtual Programming Consent Form
Boys & Girls Clubs of Harford & Cecil Counties is providing distance-based, virtual programming for Club members, through which Club staff will facilitate program activities through online platforms. Boys & Girls Clubs of Harford & Cecil Counties will use software, tools and applications provided by third parties that members, parents/guardians and/or staff will access via the Internet and use for purposes of communication and programming. These platforms include: Zoom, Clubhouse@Your House, Facebook, Youtube, Instagram and Tik Tok.
This form seeks consent for your child to utilize online applications for distance-based, virtual Club program purposes. Please be aware that each application collects different information about its users and has its own privacy terms and conditions to which members must adhere. Please review these carefully before registering your member.
In order to participate in virtual Club programming, you will need to provide the following:
• Access to the internet (including wi-fi) and an electronic device such as a gaming system, phone, tablet or laptop
• Parent/guardian’s email address to receive information to register and use the virtual programming space
• Members may need help accessing the sites or may need supervision while completing the activity
We will use the online applications for the following program activities:
• Zoom & Clubhouse @ Yourhouse: used to share videos and live instruction on projects during virtual instruction;
members may interact with staff in real time at scheduled times throughout the week
• Facebook, Youtube, Instagram and Tik Tok: used to share members’ work with staff and peers and provide asynchronous virtual sessions
Our commitment to keeping the young people we serve safe is always our number one priority. Boys & Girls Clubs of Harford & Cecil Counties will actively monitor member activity on online applications and will make every effort to protect member information by, among other things, maintaining control of, and access to, the data collected; prohibiting redisclosure of member information; limiting the purposes for which the online platforms may use member information; ensuring there is no advertising and that no member information is collected for commercial purposes.
Further, all activities online must comply with Boys & Girls Clubs of Harford & Cecil Counties safety policies, including the Code of Conduct, Acceptable Use Policy, Internet Safety Policy, Prohibition of 1:1 Contact Policy, which are available upon request from the Branch Director.
If you have any questions, please feel free to contact the Branch Director.
I, Print parent/guardian name , parent/guardian of Print member’s name give permission for him/her to participate in distance-based online Club experiences at Boys & Girls Clubs of Harford & Cecil Counties.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.