Note about location:

• Club members should ONLY attend a location where they attend school.
• Transportation is NOT provided to the morning program.

Data Collection: I give my permission to Boys & Girls Clubs of Central New Mexico (BGCCNM) to collect information via online or written surveys, questionnaires, interviews, and focus groups from the minor child listed on this application. Any and all information received will be kept strictly confidential. Data gathered through these means will be summarized in the aggregate and will exclude all references to any individual responses. The aggregated results of these analyses may be shared with Club staff, BGCA, funders, and other community stakeholders to evidence program effectiveness and/or Club impact on our members. This release may be revoked at any time by contacting the BGCCNM in writing.

Medical: I give permission to the BGCCNM to seek emergency medical treatment for my minor child if I cannot be reached. I will be responsible for any/all costs of medical attention and treatment.

Transportation: I understand that Parents and Club members may be responsible for their own transportation to school.

Data Sharing: I give my permission to the BGCCNM to share information about the minor child listed on this application with Boys & Girls Clubs of America (BGCA) for research purposes and/or to evaluate the program’s effectiveness. Information that will be disclosed to BGCA may include the information provided on this membership application form, information provided by the minor child’s school or school district, and other information collected by BGCCNM, including data collected via surveys or questionnaires. Further, I authorize the school to share information about my child with Boys & Girls Clubs including academic performance, discipline records, Individual Education Plans (IEPs), etc. All information provided to BGCA will be kept confidential. This release may be revoked at any time by contacting the BGCCNM in writing.

Media Waiver: I give permission for my child’s picture, video image, or any other graphic depiction or likeness, to be used by BGCCNM, Boys & Girls Clubs of America and its affiliates or donors and acknowledge neither my child nor I will receive payment for same.

Miscellaneous: I understand that the Boys & Girls Club is not responsible for lost or stolen items. Each Club has the right to make membership decisions based on the resources and capacity of their facility and staff. BGCCNM reserves the right to decline the application, rescind the enrollment of, or suspend any youth that cannot successfully associate with other club members

I, the parent/guardian of the minor child listed on this application, on behalf of the minor child listed herein and for ourselves, our heirs, executors and administrators, hereby release, waive, acquit and forever discharge the Boys & Girls Clubs of Central New Mexico (BGCCNM) and Boys & Girls Clubs of America (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

Please be sure that you have entered correct information. Typos in phone numbers and emails will prevent us from getting in contact with you about your registration.

Do not leave questions blank or give incorrect information. All missing information will need to be collected prior to member's first day.