Please note that this application is for the school year of 2026-2027. You will be contacted soon by the Director responsible from the clubhouse that you selected. Thank you for completing this early! We look forward to having you as a volunteer at WBGC. High School Students: Complete this form to express your interest in volunteering at Wakeman Boys & Girls Club. Choose the site(s) below
What location(s) do you prefer to volunteer at?
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Smilow-Burroughs Clubhouse
Southport Clubhouse (very limited availability as our volunteers come from Keystone and Torch Club) (Wednesdays)
Madison Avenue Clubhouse
McKinley School Mentoring (Mondays, Wednesdays and Thursdays)
Holland Hill School Mentoring (Tuesdays)
SBC Football Program
Full Name (As you would read it on your formal documents, ex: birth certificate)
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First Name
Last Name
Nickname (if you use one instead of your full first name)
Date of Birth
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Month
-
Day
Year
Date
Email. Please use the email that you check regurlarly. This should NOT be a school email please
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example@example.com
Gender
Female
Male
Non Binary
Other
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
Current Grade Level
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9th
10th
11th
12th
High School Attending
Parent Email
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You will be required to submit to a background check, attend an orientation and complete online training through Boys & Girls Clubs of America. Please initial below to confirm you will complete the First Advantage Background Check in a timely manner.
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Are you volunteering for service hours for a club, school, program or other required program?
Yes
No
Yes as well as hours above and beyond what is required for aa program
If yes, then please provide the name and contact information for your supervisor
Do you have prior experience with children (not required)?
Yes, paid.
Yes, volunteer.
Yes, with family.
No.
If yes, please briefly describe your responsibilities or interactions, frequency, and ages of children.
If you have any other work experience, please list employment including responsibilities, dates, supervisor and employment location.
Are you involved in any sports, theater, activities or jobs that may take up a significant amount of time? Answering yes does not disqualify you.
In order to volunteer with Wakeman Boys & Girls Club, you must provide the names of two contacts so we may conduct a reference check. Choose individuals who can speak to your character. Consider listing a coach, employer, teacher, clergy, neighbor, or volunteer supervisor. One reference can be an adult who is related to you.
Reference #1 Name (family member)
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Reference #1 Phone Number
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-
Area Code
Phone Number
Reference #1 Email
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example@example.com
Reference #2 Name NON family member
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First Name
Last Name
Reference #2 Email
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example@example.com
Reference #2 phone
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-
Area Code
Phone Number
Volunteering at Wakeman Boys & Girls club is typically once a week, outside of regular school hours. All programs and locations may not be available. Please indicate the days and seasons you are available. Check all that apply.
Days of the week available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Season Available
Fall (September to mid December)
Winter (January to early March)
Spring (March to May)
All school year
Disciplinary Policy and Standards of Employee and VolunteerConductVersion 2.1 090823 Wakeman Boys & Girls Club (WBGC) expects all employeesand volunteers to conduct themselves in a manner which is in the best interestsof the organization, its members and its employees. Employees and volunteersshould know that any conduct which violates a WBGC policy, or which is not inthe best interests of WBGC, will subject an employee or volunteer todiscipline, up to and including separation with or without notice. Disciplinaryactions are noted in the employee’s personnel file and volunteer records. WBGC has established policies and procedures for theconvenience and protection of all its employees and volunteers. A violation ofany of these policies and procedures is considered misconduct and appropriatedisciplinary procedures will be initiated. Disciplinary action may include, butis not limited to, the following: verbal warning, written warning, suspensionwithout pay and separation. There is no guarantee that one form of disciplinaryaction will necessarily precede another. The appropriate disciplinary actionwill be determined by the Unit Executive Director, direct supervisor and/or theCEO. The following includes but is not limited to some of themore common examples of policy violations & misconduct: • Any one-on-one interaction with a WBGC member that is not held in an opensetting;• Failure to follow child abuse state mandatory reporting laws;• Disclosure of confidential WBGC, WBGC member or employee/volunteer informationto unauthorized parties;• Supplying false or misleading information in an employment or volunteerapplication or elsewhere, or falsifying any WBGC record;• Possession of weapons on or off premises while performing duties for the WBGC;• Immoral or indecent conduct; soliciting persons for immoral purposes;• Insubordination, including but not limited to, refusing to obey an order ordirective of a supervisor or WBGC official;• Disruptive conduct, including but not limited to gambling; fighting; horseplay;coercion; intimidation or threats against WBGC employees or volunteers;vulgarity; or, abusive treatment of the public, fellow employees, volunteers,or WBGC members;• Theft or unauthorized possession or removal of property or money belonging toWBGC, employees, volunteers, members or third parties;• Making or publishing false, vicious or malicious statements concerning anemployee, volunteer, member, supervisor, or other WBGC official, or WBGCservices;• Excessive tardiness, absenteeism, or leaving early; or leaving work areawithout permission;• Destruction or misuse of property or equipment;• Failure to comply with WBGC policies and procedures;• The unlawful manufacture, distribution, dispensing, possession or use of anillegal or controlled substance on or in WBGC property;• Conviction of a felony;• Performing work of substandard quality or quantity; or• Violation of fire or safety regulations. The above list is not all-inclusive. Employees andvolunteers are expected to perform their duties with integrity, good sense,dignity and courtesy. Volunteer Please sign below.
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Volunteer Name
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First Name
Last Name
Date of Signature
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Month
-
Day
Year
Date
The following must be completed by an adult parent or guardian:
Please read and sign to accept the waiver.
TEEN’S HEALTH:Medical, allergies, medications, special needs or related concerns staff should be aware?
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Yes
No
If yes, please explain.
Parent or Guardian Name
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First Name
Last Name
Relationship to Teen Applicant (e.g. parent, mom, dad, guardian, step parent)
Parent Email
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Confirmation Email
example@example.com
Parent or Guardian Cell Phone
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-
Area Code
Phone Number
Parent or Guardian Work or Home Phone
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Area Code
Phone Number
Parent or Guardian Employer
Parent/Guardian Agreement – Teen Volunteer Programs I/we hereby certify my/our child is physically able to participate in all programs offered by the Wakeman Memorial Association, Inc., commonly known as “Wakeman Boys &Girls Club” and referred in this agreement as “WBGC”. In consideration of this application being accepted by WBGC,I/we do hereby waive and release, for myself/ourselves, my/our heirs, executors, administrators or representatives and for my/our child and his/her heirs, executors administrators, or representatives, any and all rights or claims for damages or other relief that I/we or he/she may have against the Wakeman Memorial Association, Inc. or its authorized agents, for any and all injuries that may be suffered by my/our child as a result of his/her participation in any or all of the Club’s programs. I/we further agree that our child shall accept and abide by the direction, instruction and authority of WBGC appointees, staff and coaches. I/we further agree that our child shall respect the rights and privileges of others and abide by the rules and courtesies of fair play and sportsmanship. I/we further agree to accept full responsibility for all WBGC equipment or uniforms as may be issued or lent to my/our child pursuant to his/her participation in the above and I/we shall compensate WBGC for any loss, destruction or damage to such equipment or uniforms. I/we give permission for my/our child to be transported by bus or Club van for program related field trips. I/we understand that once accepted as a WBGC Teen Volunteer, my child must complete a criminal background check through First Advantage, attend an in-person WBGC Volunteer Orientation and participate in Boys & Girls Clubs of America online safety trainings that includes topics of child abuse awareness and prevention. I/we understand:- Violation of any of terms or provisions of this application may result in suspension or expulsion from participation.- WBGC sponsored activities and participants may be photographed or videotaped, and I hereby consent to use of my child’s picture and likeness for WBGC related promotional purpose without further consideration.- As a WBGC member, my child will have access to the Internet. While precautions are taken, it is possible he/she may access inappropriate sites. WBGC has rules and consequences at the Club for such behavior; however the Club will not be responsible for the consequences of such access to inappropriate material by members.- In case of emergency, WBGC will seek emergency medical treatment for my child if I cannot be reached. I will be responsible for any/all costs of medical attention and treatment.- WBGC may collect information via online or written surveys, questionnaires, interviews, focus groups and membership applications. Results of these analyses may be shared with WBGC staff, Boys & Girls Clubs of America, funders and other community stakeholders to evidence Club/program/member effectiveness and impact.- WBGC is not responsible for lost or stolen items.- Parents/members are responsible for their own transportation to and from WBGC.- WBGC is a drop-in facility, meaning members have ability to come to, and leave Club as they wish. It is parent’s responsibility to discuss their expectations with their own child. WBGC staff provide members and guests a safe, secure Club, but WBGC is not responsible for children who choose to leave Club with/without parent permission.- WBGC’s after-school program, serving 6 through 12 year olds, is exempt from State of Connecticut childcare licensure as per CT Office of Early Childhood. All WBGC programs adhere to membership and safety standards set forth by Boys & Girls Clubs of America.- I/we hereby certify we have read, fully understand and agree to terms and provisions contained in this agreement. Parent or Guardian sign below
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Submit
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