PARENT OR GUARDIAN APPROVAL OF MEMBERSHIP
(Please read and sign below):
Parental Release
I understand my child is free to come anytime the Club is open and is required to check in and check out of the Club. If my child chooses to leave they will not be permitted to return. It is the responsibility of me and my child to determine whatever arrival and departure method is the best for us.
Members who receive scholarship assistance must attend at least 4 days of the week to maintain 'member in good standing' status.
I understand my child will be required to do academics while at the Club.
I give my child permission to participate in the Club�s activities within or near the Club�s facility.
I, the parent or legal guardian grant permission and authorize staff of the Vacaville Neighborhood Boys & Girls Clubs to obtain school records, grade reports, and access to School Loop/AERIES by signing my signature below.
I also grant permission to the staff of the Vacaville Neighborhood Boys & Girls Clubs to speak to teachers, counselors, and administrators to exchange information regarding the above named child. The purpose of the exchange is to help both organizations work together to help the student be successful in school, at the Club, and in the community. This release is valid for one year and may be revoked at any time by contacting the Vacaville Unified School District or the Vacaville Neighborhood Boys & Girls Club in writing.
Medical Treatment
I authorize Club personnel, EMT, physician, or hospital to administer emergency medical treatment in the event of an accident or sudden illness.
Technology
I hereby give permission to my child to utilize computer equipment and the internet at the VNBGC. I understand that my child must follow club computer rules in order to maintain this privilege. I also am liable for replacing equipment or software if my child damages and/or makes the equipment useless.
Survey & Questionnaires
I give my permission to the VNBGC to use my child�s school data for the purpose of Club assessments/surveys.
Miscellaneous
I give my consent and allow my child to be photographed and their picture, without identification, may be used for promotional purposes.
I voluntarily submit my child in programs and I understand that prevention based programming is available for my child at the Club. A trained staff member has my permission to discuss, at a level determined to be age appropriate, the following subject matters: drugs and alcohol, chemical abuse, human anatomy, mental health issues, interpersonal relationships, and values clarification.
I revoke my rights to any membership scholarship provided by VNBGC in the event that we are not meeting the attendance requirement or fulfilling request volunteer hours.
I understand that if my child is picked up after closing time, I will be charged a late pick-up fee of $1 per minute. Any child left 30 minutes after the Club is closed, it is by law considered abandoned and must be reported to the authorities, who will then pick up the child.
I agree to notify the VNBGC if there are any changes in the member's contact information.
I have read the information above and give my consent and authorization for my child to join the Vacaville Neighborhood Boys & Girls Club.
Liability Release:
I, undersigned, am the legal guardian of the above named child and hereby give my child permission to participate in activities at The Vacaville Neighborhood Boys & Girls Club (VNBGC). I understand that this is not a licensed child care facility. I will not hold the VNBGC responsible for any actions, accidents, injuries or losses which may occur as a result of my child�s participation in this program. I agree to indemnify and hold harmless the VNBGC, Board of Directors, officers, staff and its agents, and the City of Vacaville from all liability which may occur as a result of my child�s participation in summer camps.
Travel & Transportation:
I authorize travel on the city transit system, City Coach, in the Club van, or on a chartered bus during the summer program for the purpose of a fieldtrip. I understand that the VNBGC can revoke my child�s ride privileges at any time due to negative behavior and that VNBGC is not liable for any injuries that may occur while traveling.
#00FF00
Please sign and date below:
PARENT OR GUARDIAN APPROVAL OF MEMBERSHIP
(Please read and sign below):
Parental Release
I understand my child is free to come anytime the Club is open and is required to check in and check out of the Club. If my child chooses to leave they will not be permitted to return. It is the responsibility of me and my child to determine whatever arrival and departure method is the best for us.
Members who receive scholarship assistance must attend at least 4 days of the week to maintain 'member in good standing' status.
I understand my child will be required to do academics while at the Club.
I give my child permission to participate in the Club�s activities within or near the Club�s facility.
I, the parent or legal guardian grant permission and authorize staff of the Vacaville Neighborhood Boys & Girls Clubs to obtain school records, grade reports, and access to School Loop/AERIES by signing my signature below.
I also grant permission to the staff of the Vacaville Neighborhood Boys & Girls Clubs to speak to teachers, counselors, and administrators to exchange information regarding the above named child. The purpose of the exchange is to help both organizations work together to help the student be successful in school, at the Club, and in the community. This release is valid for one year and may be revoked at any time by contacting the Vacaville Unified School District or the Vacaville Neighborhood Boys & Girls Club in writing.
Medical Treatment
I authorize Club personnel, EMT, physician, or hospital to administer emergency medical treatment in the event of an accident or sudden illness.
Technology
I hereby give permission to my child to utilize computer equipment and the internet at the VNBGC. I understand that my child must follow club computer rules in order to maintain this privilege. I also am liable for replacing equipment or software if my child damages and/or makes the equipment useless.
Survey & Questionnaires
I give my permission to the VNBGC to use my child�s school data for the purpose of Club assessments/surveys.
Miscellaneous
I give my consent and allow my child to be photographed and their picture, without identification, may be used for promotional purposes.
I voluntarily submit my child in programs and I understand that prevention based programming is available for my child at the Club. A trained staff member has my permission to discuss, at a level determined to be age appropriate, the following subject matters: drugs and alcohol, chemical abuse, human anatomy, mental health issues, interpersonal relationships, and values clarification.
I revoke my rights to any membership scholarship provided by VNBGC in the event that we are not meeting the attendance requirement or fulfilling request volunteer hours.
I understand that if my child is picked up after closing time, I will be charged a late pick-up fee of $1 per minute. Any child left 30 minutes after the Club is closed, it is by law considered abandoned and must be reported to the authorities, who will then pick up the child.
I agree to notify the VNBGC if there are any changes in the member's contact information.
I have read the information above and give my consent and authorization for my child to join the Vacaville Neighborhood Boys & Girls Club.
Liability Release:
I, undersigned, am the legal guardian of the above named child and hereby give my child permission to participate in activities at The Vacaville Neighborhood Boys & Girls Club (VNBGC). I understand that this is not a licensed child care facility. I will not hold the VNBGC responsible for any actions, accidents, injuries or losses which may occur as a result of my child�s participation in this program. I agree to indemnify and hold harmless the VNBGC, Board of Directors, officers, staff and its agents, and the City of Vacaville from all liability which may occur as a result of my child�s participation in summer camps.
Travel & Transportation:
I authorize travel on the city transit system, City Coach, in the Club van, or on a chartered bus during the summer program for the purpose of a fieldtrip. I understand that the VNBGC can revoke my child�s ride privileges at any time due to negative behavior and that VNBGC is not liable for any injuries that may occur while traveling.
#00FF00
Please sign and date below:
PARENT OR GUARDIAN APPROVAL OF MEMBERSHIP
(Please read and sign below):
Parental Release
I understand my child is free to come anytime the Club is open and is required to check in and check out of the Club. If my child chooses to leave they will not be permitted to return. It is the responsibility of me and my child to determine whatever arrival and departure method is the best for us.
Members who receive scholarship assistance must attend at least 4 days of the week to maintain 'member in good standing' status.
I understand my child will be required to do academics while at the Club.
I give my child permission to participate in the Club�s activities within or near the Club�s facility.
I, the parent or legal guardian grant permission and authorize staff of the Vacaville Neighborhood Boys & Girls Clubs to obtain school records, grade reports, and access to School Loop/AERIES by signing my signature below.
I also grant permission to the staff of the Vacaville Neighborhood Boys & Girls Clubs to speak to teachers, counselors, and administrators to exchange information regarding the above named child. The purpose of the exchange is to help both organizations work together to help the student be successful in school, at the Club, and in the community. This release is valid for one year and may be revoked at any time by contacting the Vacaville Unified School District or the Vacaville Neighborhood Boys & Girls Club in writing.
Medical Treatment
I authorize Club personnel, EMT, physician, or hospital to administer emergency medical treatment in the event of an accident or sudden illness.
Technology
I hereby give permission to my child to utilize computer equipment and the internet at the VNBGC. I understand that my child must follow club computer rules in order to maintain this privilege. I also am liable for replacing equipment or software if my child damages and/or makes the equipment useless.
Survey & Questionnaires
I give my permission to the VNBGC to use my child�s school data for the purpose of Club assessments/surveys.
Miscellaneous
I give my consent and allow my child to be photographed and their picture, without identification, may be used for promotional purposes.
I voluntarily submit my child in programs and I understand that prevention based programming is available for my child at the Club. A trained staff member has my permission to discuss, at a level determined to be age appropriate, the following subject matters: drugs and alcohol, chemical abuse, human anatomy, mental health issues, interpersonal relationships, and values clarification.
I revoke my rights to any membership scholarship provided by VNBGC in the event that we are not meeting the attendance requirement or fulfilling request volunteer hours.
I understand that if my child is picked up after closing time, I will be charged a late pick-up fee of $1 per minute. Any child left 30 minutes after the Club is closed, it is by law considered abandoned and must be reported to the authorities, who will then pick up the child.
I agree to notify the VNBGC if there are any changes in the member's contact information.
I have read the information above and give my consent and authorization for my child to join the Vacaville Neighborhood Boys & Girls Club.
Liability Release:
I, undersigned, am the legal guardian of the above named child and hereby give my child permission to participate in activities at The Vacaville Neighborhood Boys & Girls Club (VNBGC). I understand that this is not a licensed child care facility. I will not hold the VNBGC responsible for any actions, accidents, injuries or losses which may occur as a result of my child�s participation in this program. I agree to indemnify and hold harmless the VNBGC, Board of Directors, officers, staff and its agents, and the City of Vacaville from all liability which may occur as a result of my child�s participation in summer camps.
Travel & Transportation:
I authorize travel on the city transit system, City Coach, in the Club van, or on a chartered bus during the summer program for the purpose of a fieldtrip. I understand that the VNBGC can revoke my child�s ride privileges at any time due to negative behavior and that VNBGC is not liable for any injuries that may occur while traveling.
#00FF00
Please sign and date below:
PARENT OR GUARDIAN APPROVAL OF MEMBERSHIP
(Please read and sign below):
Parental Release
I understand my child is free to come anytime the Club is open and is required to check in and check out of the Club. If my child chooses to leave they will not be permitted to return. It is the responsibility of me and my child to determine whatever arrival and departure method is the best for us.
Members who receive scholarship assistance must attend at least 4 days of the week to maintain 'member in good standing' status.
I understand my child will be required to do academics while at the Club.
I give my child permission to participate in the Club�s activities within or near the Club�s facility.
I, the parent or legal guardian grant permission and authorize staff of the Vacaville Neighborhood Boys & Girls Clubs to obtain school records, grade reports, and access to School Loop/AERIES by signing my signature below.
I also grant permission to the staff of the Vacaville Neighborhood Boys & Girls Clubs to speak to teachers, counselors, and administrators to exchange information regarding the above named child. The purpose of the exchange is to help both organizations work together to help the student be successful in school, at the Club, and in the community. This release is valid for one year and may be revoked at any time by contacting the Vacaville Unified School District or the Vacaville Neighborhood Boys & Girls Club in writing.
Medical Treatment
I authorize Club personnel, EMT, physician, or hospital to administer emergency medical treatment in the event of an accident or sudden illness.
Technology
I hereby give permission to my child to utilize computer equipment and the internet at the VNBGC. I understand that my child must follow club computer rules in order to maintain this privilege. I also am liable for replacing equipment or software if my child damages and/or makes the equipment useless.
Survey & Questionnaires
I give my permission to the VNBGC to use my child�s school data for the purpose of Club assessments/surveys.
Miscellaneous
I give my consent and allow my child to be photographed and their picture, without identification, may be used for promotional purposes.
I voluntarily submit my child in programs and I understand that prevention based programming is available for my child at the Club. A trained staff member has my permission to discuss, at a level determined to be age appropriate, the following subject matters: drugs and alcohol, chemical abuse, human anatomy, mental health issues, interpersonal relationships, and values clarification.
I revoke my rights to any membership scholarship provided by VNBGC in the event that we are not meeting the attendance requirement or fulfilling request volunteer hours.
I understand that if my child is picked up after closing time, I will be charged a late pick-up fee of $1 per minute. Any child left 30 minutes after the Club is closed, it is by law considered abandoned and must be reported to the authorities, who will then pick up the child.
I agree to notify the VNBGC if there are any changes in the member's contact information.
I have read the information above and give my consent and authorization for my child to join the Vacaville Neighborhood Boys & Girls Club.
Liability Release:
I, undersigned, am the legal guardian of the above named child and hereby give my child permission to participate in activities at The Vacaville Neighborhood Boys & Girls Club (VNBGC). I understand that this is not a licensed child care facility. I will not hold the VNBGC responsible for any actions, accidents, injuries or losses which may occur as a result of my child�s participation in this program. I agree to indemnify and hold harmless the VNBGC, Board of Directors, officers, staff and its agents, and the City of Vacaville from all liability which may occur as a result of my child�s participation in summer camps.
Travel & Transportation:
I authorize travel on the city transit system, City Coach, in the Club van, or on a chartered bus during the summer program for the purpose of a fieldtrip. I understand that the VNBGC can revoke my child�s ride privileges at any time due to negative behavior and that VNBGC is not liable for any injuries that may occur while traveling.
#00FF00
Please sign and date below:
PARENT OR GUARDIAN APPROVAL OF MEMBERSHIP
(Please read and sign below):
Parental Release
I understand my child is free to come anytime the Club is open and is required to check in and check out of the Club. If my child chooses to leave they will not be permitted to return. It is the responsibility of me and my child to determine whatever arrival and departure method is the best for us.
Members who receive scholarship assistance must attend at least 4 days of the week to maintain 'member in good standing' status.
I understand my child will be required to do academics while at the Club.
I give my child permission to participate in the Club�s activities within or near the Club�s facility.
I, the parent or legal guardian grant permission and authorize staff of the Vacaville Neighborhood Boys & Girls Clubs to obtain school records, grade reports, and access to School Loop/AERIES by signing my signature below.
I also grant permission to the staff of the Vacaville Neighborhood Boys & Girls Clubs to speak to teachers, counselors, and administrators to exchange information regarding the above named child. The purpose of the exchange is to help both organizations work together to help the student be successful in school, at the Club, and in the community. This release is valid for one year and may be revoked at any time by contacting the Vacaville Unified School District or the Vacaville Neighborhood Boys & Girls Club in writing.
Medical Treatment
I authorize Club personnel, EMT, physician, or hospital to administer emergency medical treatment in the event of an accident or sudden illness.
Technology
I hereby give permission to my child to utilize computer equipment and the internet at the VNBGC. I understand that my child must follow club computer rules in order to maintain this privilege. I also am liable for replacing equipment or software if my child damages and/or makes the equipment useless.
Survey & Questionnaires
I give my permission to the VNBGC to use my child�s school data for the purpose of Club assessments/surveys.
Miscellaneous
I give my consent and allow my child to be photographed and their picture, without identification, may be used for promotional purposes.
I voluntarily submit my child in programs and I understand that prevention based programming is available for my child at the Club. A trained staff member has my permission to discuss, at a level determined to be age appropriate, the following subject matters: drugs and alcohol, chemical abuse, human anatomy, mental health issues, interpersonal relationships, and values clarification.
I revoke my rights to any membership scholarship provided by VNBGC in the event that we are not meeting the attendance requirement or fulfilling request volunteer hours.
I understand that if my child is picked up after closing time, I will be charged a late pick-up fee of $1 per minute. Any child left 30 minutes after the Club is closed, it is by law considered abandoned and must be reported to the authorities, who will then pick up the child.
I agree to notify the VNBGC if there are any changes in the member's contact information.
I have read the information above and give my consent and authorization for my child to join the Vacaville Neighborhood Boys & Girls Club.
Liability Release:
I, undersigned, am the legal guardian of the above named child and hereby give my child permission to participate in activities at The Vacaville Neighborhood Boys & Girls Club (VNBGC). I understand that this is not a licensed child care facility. I will not hold the VNBGC responsible for any actions, accidents, injuries or losses which may occur as a result of my child�s participation in this program. I agree to indemnify and hold harmless the VNBGC, Board of Directors, officers, staff and its agents, and the City of Vacaville from all liability which may occur as a result of my child�s participation in summer camps.
Travel & Transportation:
I authorize travel on the city transit system, City Coach, in the Club van, or on a chartered bus during the summer program for the purpose of a fieldtrip. I understand that the VNBGC can revoke my child�s ride privileges at any time due to negative behavior and that VNBGC is not liable for any injuries that may occur while traveling.
#00FF00
Please sign and date below:
