Membership Application

Welcome! We are so excited and thankful you have made the decision to enroll your child in the Boys & Girls Club of the Greater West Plains Area. The Boys & Girls Club has made a positive impact on the lives of thousands of kids across the country, and we are excited to make our division of the Club the best it can possibly be. Please note that this form and the application will not be accepted without all forms completed, a copy of your child’s shot records, and payments received.

It is vital that this information is accurate and correct; as it is necessary to maintain funding, state compliance, and records for The Boys & Girls Club. Here are just a few of our goals at the Club:

• Provide a safe place for your child to learn, grow, and be themselves. • Develop programs that help promote a positive self-image, while also

promoting good character and leadership. • Prepare your child for a brighter future; including attending and graduating

high school and attending a form of higher education or trade school. • Give every child a chance to be the best they can be, while providing positive

role models. • Offer support and guidance as they journey down a path leading to a great

future. Please feel free to contact anyone at the Club if you have any questions. You can also visit our website, www.bgcwp.org for more information. Location: 613 West First Street, West Plains, MO 65775 Phone: 417-204-2582Fax: 417.255.0566 Email: membership@bgcwp.com

Membership:

I understand that if membership is revoked, no refund will be awarded. I understand that the Boys & Girls Clubs of the Greater West Plains Area do not accept responsibility for loss/damaged property. I hereby release the Boys & Girls Club, its employees, associates, and contributors from liability from any injury incurred by my son/daughter while participating. I further understand that the Boys & Girls Club has an “Open Door” policy, which means that if my son/daughter leaves without authorization, the Boys & Girls Club of the Greater West Plains Area is not responsible; however, the primary contact will be notified. The Boys & Girls Clubs of the Greater West Plains Area is not a state licensed day care. Expectations for Parents/Guardian s:

We recognize that an important part of our program’s success is the support that we receive from parents. A strong partnership must exist between the Club staff and the family in order for us to be a safe and loving place for members to learn and grow.

Through this partnership, parents/guardians are expected to:

• Maintain open communication with the staff, informing us of any problems or accomplishments. • Respond as quickly as possible when members need to be picked up (upon closing time, as a consequence, or in case of injury or

illness). • Acknowledge and support our discipline and conflict resolution philosophy. • Approach conflict with staff and/or other parents in a manner that is respectful and is not witnessed by members or other

children. • Refrain from any physical punishment of children or verbal attacks of children on Club property.

Parents/guardians can expect from Club staff: • Open communication regarding members’ difficulties and accomplishments. • Phone call or letter home informing parents/guardians of any incidents that might be of concern. • Members will be treated with dignity and respect and will be given every opportunity to succeed within the parameters of the

Club rules. • Every effort will be made to ensure that Club members are safe and experience success.

• Up-to-date information regarding field trips, programs and events is provided. Programs:

The Boys & Girls Clubs of the Greater West Plains Area offers programs, which enhance learning in character and leadership development, education and career opportunities, sports, fitness and recreational development as well as health and life skills. During Program Hours, youth will be asked to participate in program activities. Some of these activities will consist of:

• Games • High Yield Learning activities • Field Trips (There are NO refunds on field trips unless the trip is canceled or re-scheduled by the Boys & Girls Club. This means if you have signed up your child for a field trip and you are NOT able to attend, there will be NO refund as we have already processed the necessary paperwork and fees to implement the field trip.) • Discussion about health issues including sex education/abstinence & drug resistance, bullying, and peer pressure • Completing questionnaires and/or surveys • Participation in groups and group processes

• Sharing information with schools about academics, health, behavior and attendance. Technology:

I give permission for my child to use the Boys & Girls Clubs of the Greater West Plains Area, Technology Program; including but not limited to computers, printers, software, the Internet, database access, and audio-visual equipment. By signing below, I will discuss with my child the importance of following the rules and will accept responsibility for the repair/replacement costs due to my child’s negligence or destructive behavior Parent Handbook:

I have received and read the Parent Handbook. By signing below I hold myself and my child responsible for everything in the Handbook.

Transportation Permission Slip

Missouri’s law requires children ages 7 & under who weigh less than 80 pounds and are less than 4’9” in height to be secured in an appropriate child passenger restraint system or booster seat.

TRANSPORTATION AND LIABILITY RELEASE I give permission for my child to ride the Boys & Girls Clubs of the Greater West Plains Area transportation for field trips or any other necessary travel for Club activities. I understand that all precautions will be taken for the safety of my child and I will not hold the B&GCS, its officers, or volunteers responsible for any accident occurring during travel. I authorize the staff in charge to approve medical treatment for my child in the event of an emergency. I also understand that the Boys & Girls Club reserves the right to call 911 to seek help for your child if they feel they are in immediate danger.

Parent Signature: _________________________________________Date: _______________________

During the course of the day we sometimes leave the building for non-scheduled activities and/or go to another Boys & Girls Club for an activity. In these situations, we do not travel far so your child may quickly be returned to the building if you need to p ick him/her up.

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Photo & Video Release Form

I, ____________________________, hereby authorize The Boys and Girls Club of the Greater West Plains area, to use, reproduce, and/or publish photographs and/or video that may pertain to my child, ________________________ including his or her image, likeness and/or voice without compensation. I understand that this material may be used in various publications including the Club website, and various Club materials or for other related endeavors.This material may also appear on the Boys and Girls Club of the Greater West Plains area webpage. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, the Corporation or project sponsor may publish materials, use my child’s name, photograph, and/or make reference to my child in any manner that The Boys and Girls Club of the Greater West Plains area deems appropriate in order to promote/publicize service opportunities.

Parent name: ________________________________________

Parent signature: _____________________________________

Date: ______________________________________________

of the Greater West Plains Area

Technology PolicyOur current technology policy is that members are permitted to bring devices and use them during Tech Time, as long as they are not a distraction during programming, are used appropriately, and do not cause issues with other members.

We are not responsible for lost or damaged devices, so it is up to members and their parents as to whether or not they are allowed to bringthem to the club. We have a locked cabinet in the Front Office that members can safely store their electronics in while not in use.

Thanks for you cooperation!!