• Enrollment for 18 & up

    Welcome to ELC Haverhill! We're glad you're here. We hope to challenge, encourage and empower you to grow in self-leadership and positively impact others. We are here to support you to become a culture curator.
  • Client Info

  • Household Info

  • Consent

    Program participation form
  • 1. The undersigned on their own behalf hereby releases, waives, discharges, and covenants not to sue The Emerging Life Youth Center (ELYC) and or any branches of the Emerging Life Centers (ELC) branches thereof, its directors, officers, employees, and agents (hereinafter referred to as "releases") from all liability to the undersigned and or all personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned whether caused by the negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with The ELYC, ELC

    2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any, loss, liability, damage or cost I may incur due to the presence of the undersigned in, upon or about The ELYC, ELC premises or in any way observing or using any facilities or equipment of The ELYC, ELC or participating in any program affiliated with The ELYC, ELC whether caused by the negligence of the releases or otherwise.

    3. 'I' THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned due to negligence of releasees or otherwise while in, about or upon the premises of The ELYC, ELC and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with The ELYC, ELC. THE UNDERSIGNED further expressly agrees that the foregoing RELEASE WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT and further agrees that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.

    4. The client and or client's parent/guardian understand that inner-wellness support services are offered as a part of the program and consent to participation. Inner-wellness specialists are available to offer emotional, spiritual and mental health support to clients and encourage positive decision making. Inner-wellness specialist, ELC staff nor any part of the ELC/ELYC program(s) do not replace nor is intended to substitute or provide professional mental health services.

    5. Inner-wellness specialist and or ELC center staff may offer guidance in navigating emotional turbulence, addressing specific situational concerns, improving coping skills, or resolving interpersonal conflicts. Client information may be shared with staff, parents (if client is a minor) and disclosed if the clients safety or wellness is presumed at risk. Crisis intervention or EMS may be involved if a client is becoming unstable, poses a potential threat to themselves or others, or at the discretion of the inner wellness specialist/ ELC staff. If the client is a minor a parent or guardian will also be contacted.

    6. The client and or client's parent/guardian understand and acknowledge that the inner-wellness specialist, ELC staff and any part of the ELC/ELYC program(s) cannot be held responsible or liable for any outcomes or consequences resulting from the information or support provided.

  • I :
    am voluntarily enrolling to participate in the Emerging Life Youth Center/ ELC Haverhill program. I have read, understood and agree to the included consents.

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  • Client Agreement

    Client conduct expectations
  • Welcome to the Emerging Life Youth Center (ELYC)! We’re happy you’re here.

    The ELYC/ ELC programs are designed with you in mind. We want you to know that you are valued, worthy, respected, and welcome. Our center is a place where you can learn and grow in a brave space environment with the support of your community and peers. To create/maintain this space for all it is important that you treat staff, your peers, community leaders, and others, as valued, worthy, welcomed, and respected.

    To create/maintain a safe brave welcoming environment :
    I will not use foul or derogatory language, I will not use threats, aggressive behavior, or engage in violence. I will not bring or distribute weapons, cognitive altering substances (both legal and or illegal), or explicit graphic content into the center or on center grounds. I will not participate in gang related activities while at or in connection to the center.

    I commit to having a personal expectation of myself to take direction from center staff and leadership and comply with redirection requests, including removing myself from a space or situation in which conflict is becoming escalated. I agree to follow center policy and direction for conflict resolution and will bring to center staff/leadership’s attention if I feel unsafe, or unstable or become aware of others who may be unsafe or not in keeping with this commitment.

    I understand that my enrollment and or participation in ELYC /ELC programs, activities, and use of facilities and equipment may be restricted or deferred up to and including indefinitely if I do not display a commitment to my confirmation or endanger the safety or well-being of others.

    This confirmation is a statement of my understanding of the ELYC/ ELC commitment to providing a safe, brave space for myself and others and my agreement to uphold that standard as my own.

  • CLIENT NAME:*

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  • Medical

  • You should be aware of your restrictions and avoid foods or situations that may cause you to experience an adverse reaction. To keep you safe you should be aware of and carry any emergency medications you may need and be able to independently administer them appropriately as needed. 

  • I*give consent to receive first aid and or be transported and receive medical care in the event of an emergency  
          

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