Choose the location where your child will attend.
Please note, by indicating 'Yes' on the permission field below you acknowledge that you understand that in the event of an emergency every attempt will be made to contact you, but if you cannot be reached you are giving your permission to the physician selected by the Boys & Girls Club staff to secure the proper treatment for your child.
I give permission to the Boys & Girls Clubs of Central Alabama to seek emergency medical treatment for my minor child if I cannot be reached. I will be responsible for any costs of medical attention and treatment.
I give my permission to the Boys & Girls Club of Clubs of Central Alabama and area Community schools to exchange information regarding the minor child listed on this application. The purpose of the exchange is to help both organizations do a better job of helping the student be successful in school, the Boys & Girls Club and in life. This release may be revoked at any time by contacting Community Schools or the Boys & Girls Clubs of Central Alabama in writing.
Surveys and Questionnaires
I, the parent/guardian of the minor child listed on this application, give permission for Boys & Girls Clubs of Central Alabama to survey my child about his or her Club experience and behaviors, skills and attitudes using Boys & Girls Clubs of America’s Youth Development Outcome measurement Tool Kit surveys or other survey instruments.
As a member of the Boys & Girls Clubs of Central Alabama, your child will have access to the Internet. While precautions are being taken, it is possible the s/he may access inappropriate sites. Boys & Girls Club will have rules and consequences at the club for such behavior; however we will not be responsible for the consequences of such access.
I understand that the Boys & Girls Clubs of Central Alabama is not responsible for lost or stolen items.
I give permission for my child’s picture, moving pictures, or any other graphic depiction or likeness, to be used by the Boys & Girls Club and its activities.
I also understand that the Club is not, nor claims to be, a licensed day care center.
I have read the complete application and this form, understanding the rules of the Boys & Girls Club and request that my child be admitted into membership. Before my child can attend I must complete the
and bring a copy of the childs birth certificate to the Club to verify age. I am signing up for membership only.
You MUST choose ONE of the Membership options below in order to complete registration.
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