El Centro Teen Center Registration Form

Fall Program starting in September 2025

Middle School Program (6-8th Grade) | Tuesday's, 3:30pm - 6:30 pm

- Duration: 9/30-11/04

High School Program (9-12th Grade) | Thursday's, 3:30pm - 6:30 pm

Duration: 10/02-11/06

Location: 85 Munroe St. Lynn, Ma 01901

El Centro Teen Center is a space where teens can build life skills, grow in leadership, and connect with friends in a fun and supportive environment. Using the Habitudes curriculum, students will explore self-awareness, decision-making, and relationship skills through engaging discussions and hands-on activities.

Our weekly programming includes:

✅ Games & Hangouts – A welcoming space to relax, enage with peers, and build community

✅ Academic Support – A dedicated space for students to work on school assignments and projects with support available

✅ Creative Learning – Opportunities for self-expression through journaling and forms of art

✅ Interactive Lessons and Discussions – Exploring soft skills through Habitudes lessons

El Centro RULES: By becoming a member of El Centro's Teen Center, you agree to observe the following rules:

I will show respect to the Teen Center by:
1. Not damaging equipment/ building or grounds
2. Not stealing from El Centro
I will show respect for others by:
1. not fighting or bullying
2. not using abusive or offensive language
3. being welcoming to all members
4. being positive about people who are different from me (race/ faith/ ability)
5. not engaging in behaviour that could be viewed as sexual harassment
6. sharing any and all equipment
I will show respect to the local community/neighborhood by:
1. Not bringing drugs or alcohol onto the premises
2. Weapons of any kind, or any object that could be used to cause harm to others or myself
3. Not causing damage to the building, grounds or neighbourhood
4. Not breaking the law or behaving in a way that could give the club a bad name
Above all, I will respect myself by being positive about my ability and support others so everyone enjoys, achieves and thrives during their time spent at El Centro.

Young people will be given two chances by members of staff and on the third warning they will be asked to leave the premises and parents will be contacted. They may also receive a ban depending on the severity of the behavior. Anyone caught with drugs or alcohol will be automatically asked to leave.

Please do not expect us to bend these rules - they have been created to protect and benefit the majority of El Centro's teens and they will be enforced rigorously.

Which program is your child/teen signing up for?*

Middle SchoolHigh School

Child / Teen's Full Name*

First NameLast Name

Gender*

MaleFemale

Child / Teen's Date of Birth*

Date

Child / Teen's Grade*

Child / Teen's School*

Child / Teens Phone Number

If Apllicable

Parent / Guardian's Full Name*

First NameLast Name

Relation to Child / Teen*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Name

First NameLast Name

Relation to Child / Teen

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Does your child have/would you consider your child to have any disabilities/learning difficulties?*

YesNo

If Yes, Please provide details

Does your child suffer from any medical conditions or allergies?*

YesNo

If Yes, Please provide details

Will your child be bringing medication to El Centro?*

YesNo

If Yes, Please provide details

I am the parent/guardian of the child/teen named above and I give consent for them to attend activities organized by El Centro.
I agree that my child/teen is committed to attending weekly throughout the duration of this program and that my child/teen will stay through the duration of program hours (3:30-6:30pm)
I give consent for my child to be taken for treatment in the event of an emergency
I agree that photos/videos can be taken of my child in order to publicise El Centro's activities.
I understand that I am responsible for ensuring my child/teen is brought to and collected from El Centro or I allow my child/teen to make their own way to and from El Centro.

Parent/Guardian*

By signing, I'm confirming that the information above is correct and agree to the declarations listed.

El Centro Teen Center Registration Form

Section 1 - Child / Teen's Information

Section 2 - Parent / Guardian Information

Section 3 - Emergency Contact Details

Section 4 - Medical Details

Declaration: