7th Grade Initiative Enrollment Packet
Thank you for your interest in the Westport Weston Family Y’s 7th Grade Initiative Program! Here at the WWFY, we are committed to supporting teens as they transition from childhood into adolescence. This program is specifically designed to give 7th graders an environment where they can develop healthy relationships with peers, caring adults as well as with themselves. 7th graders will get to experience a variety of fitness and recreational activities allowing them to discover what excites them.
Membership Account Information
PRIMARY ADULT | Name:
*
First Name
Last Name
DOB:
-
Month
-
Day
Year
Date
Gender:
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number:
*
Format: 000-000-0000.
Email:
*
example@example.com
7th GRADER | Name:
*
First Name
Last Name
DOB:
-
Month
-
Day
Year
Date
Gender:
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number:
*
-
Area Code
Phone Number
Email:
*
example@example.com
Emergency Contact Name:
*
First Name
Last Name
Emergency Contact Phone Number:
*
Format: 000-000-0000.
School Information
My child is in the following school system:
*
Bedford Middle School
Coleytown Middle School
Weston Middle School
Other
School verification document
*
Report Card
Photo ID
Other
Please attach image/scan of school verification document
*
Browse Files
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7th Grade Initiative Parent Agreement
I have received the 7th Grade Initiative Membership Policies andunderstand that it is my responsibility, and my child’s responsibility, to follow these policies.
*
I agree
I understand that my child will be responsible for completing a fitness orientation prior and quiz prior to utilizing the fitness center.
*
I agree
I understand that my child will be responsible for volunteering at the WWFY 3 times over the academic year for a total of 6 volunteer hours in order to receive a free membership.
*
I agree
I understand that my child’s membership will not be activated until all registration documents have been submitted.
*
I agree
I understand that my child must be actively engaged in a program or activity while at the WWFY.
*
I agree
I understand that there is a $5 charge to replace a lost keytag.
*
I agree
I understand that the YMCA is not responsible for lost or stolen personal belongings.
*
I agree
I understand that my child’s membership may be suspended or terminated at the discretion of the WWFY for behavioral problems that endanger other people or create an unfavorable atmosphere.
*
I agree
I understand that WWFY staff and volunteers are not responsible for the supervision of my child outside of registered program times.
*
I agree
Parent/Guardian Name:
*
First Name
Last Name
Parent/Guardian Signature:
*
Date:
*
-
Month
-
Day
Year
Date
Phone Number:
*
-
Area Code
Phone Number
Email:
*
example@example.com
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7th Grade Initiative Health History Questionnaire & PAR-Q
As part of the 7th Grade Initiative program, your child will gain access to our fitness center. We would love to learn a bit more about your child to ensure we are providing them with the appropriate level of support in the fitness center.
Current Age:
*
Height:
*
Weight:
*
Primary Physician Name:
*
Primary Physician's Phone Number:
-
Area Code
Phone Number
Date of last physical:
*
-
Month
-
Day
Year
Date
Has you doctor ever said that your child has a heart condition and have been advised to only perform physical activity recommended by a doctor?
*
no
yes
Has your child ever experienced pain in your chest when you perform physical activity?
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no
yes
Have your child ever lost balance because of dizziness or do they ever lose consciousness?
*
no
yes
Does your child have a history of epilepsy or seizures?
*
no
yes
Do your child have a bone or joint issue that could be made worse by a change in physical activity?
*
no
yes
Is your doctor currently prescribing any medication for your child?
*
no
yes
Is there any other reason why you should not engage in physical activity?
*
no
yes
If you answered yes to one or more questions, please write full details below:
Does your child participate in any sports or activities?
*
no
yes
If yes, please explain:
Does your child have any pain or injuries?
*
no
yes
If yes, please explain:
Does your child have any dietary restrictions that the YMCA staff needs to be aware of?
*
no
yes
If yes, please explain:
Do any of these allergies require that the child carry an EpiPen with them?
*
no
yes
If yes, please explain:
Is there anything unique about your child that we should be aware of?
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7th Grade Initiative Teen Code of Conduct
As part of the WWFY, teens are required to follow specific guidelines to ensure the safety of themselves and the WWFY community. As a member of the 7thGrade Initiative Program, I will model the following guidelines.
I will consistently exemplify the four core values of the Westport Weston YMCA’s characterdevelopment: Caring, honesty, respect and responsibility.
*
I agree
I will speak inrespectful tones and be kind to fellow students and members.
*
I agree
I will not use my cell phone and/or any recording device to record fellow students and/or the greater Y community while accessing the Y.
*
I agree
I will safeguard my personal items in a locked locker and will do my part to create a safe environment for all. I understand the Y is not responsible for lost or stolen property.
*
I agree
I will utilize the boys and girls youth locker rooms to store my belongings.
*
I agree
I will adhere to the attire requirements for the WWFY which includes wearing athletic shoes and shirts when participating in recreational activities or when working out in the fitness center.
*
I agree
I will complete the Teen Fitness Center Orientation packet and quiz, prior to accessing the Fitness Center.
*
I agree
I will volunteer for the YMCA 3 times over the 2023- 2024 academic year.
*
I agree
I understand that I need to check into the facility through the main entrance every time I want to workout.
*
I agree
As a member of the 7th I understand that I am eligible to bring a visitor to the facility two times per year. All visitors must check in through the main entrance and cannot be admitted through any side entrances.
*
I agree
I understand the Y reserves the right to suspend and/or terminate my membership privileges for inappropriate behavior at any time.
*
I agree
7th Grader's Name:
First Name
Last Name
Signature:
Date:
-
Month
-
Day
Year
Date
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Teen & Parent Volunteering Agreement
As part of the 7th Grade Initiative, teens are required to volunteer at the Westport Weston YMCA events three times per calendar year. In order to fulfill this requirement, students are requested to volunteer at one event per quarter. Students will be able to obtain documentation of volunteer work completed at the YMCA if they need it for extracurricular activities.
7th Grader's Name
First Name
Last Name
Signature
Date:
-
Month
-
Day
Year
Date
Parent/Guardian Name:
First Name
Last Name
Signature
Date
-
Month
-
Day
Year
Date
Submit
Thank you for your interest in our 7th Grade Initiative Program. A member of our staff will review your application and will get back to you with next steps. Please reach out to Brian Ference, Youth & Teen Manager at bference@westporty.org if you have any questions.
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