I give my permission to the Boys & Girls Clubs of the Chattahoochee Valley to collect a copy my child’s Report Card and Standardized Testing Information from the school. This is to assist my Boys & Girls Clubs in maintaining the low cost of funding the program to my family. I understand my child’s information will only be used in statistical information and never used on an individual basis. I understand I can take back my permission at any time, and my permission stops at the end of this membership year. I can, upon request, arrange to discuss the findings with my child’s Unit Director. I give my permission to the Boys & Girls Clubs of the Chattahoochee Valley to survey and interview my Child to find out what his/her behaviors, skills and attitudes are in regards to issues such as health risks and habits, positive self-esteem, respect for diversity, education and educational resources, positive relationships, career choices, and connection to community, as well as his/her experiences at the Club. I understand that the purpose of these surveys and interviews is to help find out how well the Club is meeting my child’s needs and to identify areas which may call for further attention. I also understand that this information will remain private. I understand that my child’s responses will be automatically grouped together with the responses of other Boys & Girls Clubs members for any public presentation of the findings, and that my child will never be individually linked to his/her responses. In addition, I understand that I can take back my permission at anytime, and that my permission automatically stops at the end of this one-year membership period. I can, upon written request, arrange to discuss the findings with my child’s Club Director.
I certify that I give my child permission to join the Boys & Girls Clubs of the Chattahoochee Valley, Inc., and to appear in pictures of Boys & Girls Clubs activities to be used for publicity purposes. I understand and agree that if my child must be transported to and from the Club, he/she must be picked up by closing time or a fee may be charged for waiting by staff. I further understand and agree that Boys & Girls Clubs has an open door policy and cannot be responsible for my child leaving the Club without permission. As a parent or guardian of the above child, I approve his/her joining the Boys & Girls Clubs of the Chattahoochee Valley, Inc., and agree not to hold the Boys & Girls Clubs of the Chattahoochee Valley, its Board of Directors, Officers, Staff or Volunteers responsible and/or liable, and hereby RELEASE them from liability for losses of any personal property and for any injuries or accidents suffered by my child at the Boys & Girls Clubs facilities or in connection with membership or participation in any Boys & Girls Clubs activities. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the Boys & Girls Club to hospitalize, secure proper treatment for and to order injection, anesthesia, or surgery for my child as named above. THIS REGULAR MEMBERSHIP DOES NOT INCLUDE ADMITANCE TO THE SUMMER PROGRAM. I FULLY UNDERSTAND THAT ALL FEES PAID TO THE BOYS & GIRLS CLUBS ARE NON-REFUNDABLE.
Your registration is not complete until you come into the club and pay for membership. Please bring the total amount below. (Debit Card, Credit Card or Money Order. NO Cash, NO Checks)
A copy of a birth certificate is required. You must bring in a all neccesary documentation into the club and make payment before the child can begin attending.
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