Framingham Registration 2021

Membership Registration Form

Framingham Clubhouse 2021 - 2022
New! Starting March 21,2022, we will be accepting kindergarteners!
Type of Membership *

New Renew
How many children are you registering? *
Do you want to register your child for transportation? *
Child #1 Information
Child #1 Name *
Sex *
Birthdate *

Month Day Year
Date
Age *
Child's Address *

Address

Street Address Line 2

City

ZIP
Main Cell Phone Number *
School *
Grade *
Child #2 Information
Child #2 Name
Sex
Birthdate

Month Day Year
Date
Age
Address

Address

Street Address Line 2

City

ZIP
Main Cell #
School
Grade
Medication
List any Medical, Physical, or Emotional conditions that we should be aware of to better serve your child (ex. allergies, medication, etc.)
Does your child take medication during the day? *

Yes No
If Yes, Name of Medication
Dose
Time

Hour Minutes

AM/PM Option

Parent/Guardian Information
Mother or Guardian #1
Mother/Guardian #1 *
Cell # *
Home #
Email *
example@example.com
Address *

Address

Street Address Line 2

City

ZIP
Occupation *
Employer *
Work Phone Number *
Father/Guardian #2
Cell #
Home #
Email
example@example.com
Address

Address

Street Address Line 2

City

ZIP
Occupation
Employer
Work #

Emergency Contacts

In case of emergency, if a parent/guardian cannot be reached:
Emergency Contact #1 Name *
Relationship to child *
Address *
Phone Number: *
Emergency Contact #2 Name
Relationship to child
Address
Phone #
Emergency Contact #3 Name
Relationship to child
Address
Phone #

Authorization and Consent
- I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the qualified staff at the Boys & Girls Club to transport my child to the nearest hospital.
- I understand the Club is not, nor claims to be, a licensed day care center (unless your child is the licensed program).
- I authorize the Boys & Girls Clubs of MetroWest staff/volunteers who are trained in the basics of first aid to treat my child when appropriate.
- I give permission for my child to participate in field trips by means of bus/van. I understand that I will be notified in advance of any trips.
Child's Doctor & Insurance *
Child's Doctor's Phone Number and Address: *
I give consent to have my child photographed or videotaped for public relations purposes. *

Yes No
I agree to all previous conditions listed: *

Yes No
PARENT/GUARDIAN SIGNATURE *

Clear
DATE *

Month Day Year
Date

Assumption of the Risk & Waiver of Liability Relating to 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 be 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 location, prohibited the congregation of groups of people.

Boys & Girls Clubs of MetroWest 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, program participants and their families.

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 participation in any Club program.
Parent/Guardian Signature *

Clear
Date *

Month Day Year
Date
Name of Parent/Guardian *
Name of Participant *

Transportation Contract

IMPORTANT: If you selected YES for Transportation, you need to fill this Transportation form out.
Child Name
The above listed member will follow the following BUS RULES as long as I am a member of the Boys & Girls Clubs of MetroWest:
- Respect and Listen to the bus driver
- Respect and Listen to the monitors on the bus
- Stay seated at all times
- Keep all body parts to yourself and inside the bus
- Throwing objects is not allowed on the bus or out the windows
- Inside voices and use of appropriate language
PLEASE NOTE: These rules are to ensure that all members are safe while on the bus. Failure to obey the rules will result in suspension off the bus for the entire school year.

Consequences for not following the rules:
1st Offense: Warning
2nd Offense: 2-Day Suspension off the bus
3rd Offense: Suspension off the bus for the entire school year

By signing this contract, you are agreeing to the rules and consequences if the rules are not fulfilled.
Member Name
Date

Month Day Year
Date
Parent Signature

Clear
Date

Month Day Year
Date
Parent Name (printed)

My Products

Framingham - Membership

Free Quantity

Transportation Deposit

Free Quantity

Total

$ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Membership Registration Form

Child #1 Information

Child #2 Information

Medication

Parent/Guardian Information

Mother or Guardian #1

Emergency Contacts

General Information

Authorization and Consent

Assumption of the Risk & Waiver of Liability Relating to COVID-19

Transportation Contract