Sports Leagues - Membership, Registration, & Parent Handbook

For more information call 361-853-2505 or email athletics@bgccb.org

Parent Handbook 2020-2021
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Membership Application
File Size:	764 kb
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Sports League Registration
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Receipt of Parent Handbook
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Membership Application

Youth Information:

* Indicates required field

Child's Name *

First

Last

Date of Birth (MM/DD/YYYY) *

Gender *

Ethnicity *

Child's Social Security Number (XXX-XX-XXXX) *

Previous BGC Member *

If Yes, what is child's Membership #? *

Child's Physical Address *

Line 1

Line 2

City

State

Zip Code

Country

County *

Primary Phone Number *

Primary language spoken at home *

Are there any persons legally NOT AUTHORIZED to pick up your child? *

If Yes, please list the names of any persons NOT AUTHORIZED to pick up your child. (separate individuals by comma) *

If Yes, copies of legal documentation will be required to be submitted. *

Max file size: 20MB

Name of School *

Grade Level *

Name of Teacher *

Does child receive Free/Reduced Lunch at school? *

Does the child have any health concerns, allergies, or disabilities? *

If Yes, please explain. *

Doctor's Name *

Doctor's Phone Number *

Insurance Company *

Insurance Policy # *

Insurance Type *

Hospital Preference *

Parent/Guardian Information:

Primary Parent/Guardian Name *

First

Last

Relationship to Child *

Primary Parent/Guardian Phone Number *

Primary Parent/Guardian Email *

Primary Parent/Guardian Physical Address (if different from child) *

Line 1

Line 2

City

State

Zip Code

Country

Occupation *

Employer *

Work Phone Number *

Are you currently Active or Reserve military? *

If Yes, which branch? *

Secondary Parent/Guardian Name *

First

Last

Relationship to Child *

Secondary Parent/Guardian Phone Number *

Secondary Parent/Guardian Email *

Secondary Parent/Guardian Physical Address (if different from child or Primary Parent/Guardian) *

Line 1

Line 2

City

State

Zip Code

Country

Occupation *

Employer *

Work Phone Number *

Are you currently Active or Reserve military? *

If Yes, which branch? *

Emergency Contacts:

Name of Emergency Contact #1 (Must be different from Primary Parent/Guardian) *

First

Last

Relationship to Child *

Emergency Contact #1 Phone Number *

Is Emergency Contact #1 authorized to pickup child? *

Emergency Contact #1 Email *

Name of Emergency Contact #2 *

First

Last

Relationship to Child *

Emergency Contact #2 Phone Number *

Is Emergency Contact #2 authorized to pickup child? *

Emergency Contact #2 Email *

Name of Emergency Contact #3 *

First

Last

Relationship to Child *

Emergency Contact #3 Phone Number *

Emergency Contact #3 Email *

Is Emergency Contact #3 authorized to pickup child *

Household Information:

BGCCB is a 501(c)(3) non-profit organization. The following information is necessary for our records and the funding our organization receives. The answers you provide are kept completely confidential.

Annual Household Income *

Single-Parent Household? *

Total Number of people living in the household including child? *

In the household, how many are under the age of 18 years old? *

In the household, how many are 65 years old and above? *

Parental Authorization:

I, the parent/guardian of the minor child listed on the application, for ourselves, our heirs, executors and administration, hereby release, waive, acquit and forever discharge the Boys & Girls Clubs of the Coastal Bend, and Boys & Girls Clubs of America, their representatives, successors, insurers, assigns or any other person or entity associated with any of the above organizations such as staff, directors or volunteers, from all liability, claims, demands, or causes of action for any and all loss, damage, injury or death and any claim of damages resulting from use of facilities owned or controlled by the above organizations, or participation in activities of said organizations either at or away from the Club.

I understand and agree that the Club is not responsible or legally liable for any personal property losses, stolen or for any bodily injuries incurred and suffered by my child on any Club property or in connection with any activities at any of its facilities, or while engaged in any Club activities away from the Club. I understand and agree that the Club does not provide medical insurance for my child.

I, also grant permission to managing personnel or other representatives of the Club to authorize and obtain medical care from any licensed physician, hospital or medical clinic should my child become ill or injured while participating in activities away from home, or at any times when neither available to grant authorization for medical treatment. I will furnish a certified birth certificate of the above named upon request by sponsors or supervisors. ). I further understand and agree that the Club cannot and will not administer prescription or over the counter medications of any kind to my child (or ward).

In the event of an emergency I authorize BGCBC to secure medical treatment for my child (or ward)

Please read the following, indicate Yes/No for each statement and electronically sign below indicating agreement and permission

OPEN DOOR POLICY

Open Door Policy *

I agree and understand that once my child chooses to leave, she/he may not be permitted to return that same day, unless granted permission by the Club Director of the their Unit. I understand that the Club is a drop-off facility, NOT regulated as a licensed daycare by the State of Texas and that an open campus policy is in effect at all times. I further understand that the Club is NOT responsible for the time or manner in which my child may arrive at or leave the facility. If a member chooses to leave the facility without written permission from a parent/guardian, Club discipline policy will be followed accordingly including but not limited to notifying the authorities.

PERMISSION TO SIGN OUT

Permission To Sign Out *

I give permission for my child to leave the Club without an adult. I will not hold the Boys & Girls Clubs of the Coastal Bend, nor the officers, or volunteers responsible for any injury or danger that occurs once my child has left the Club.

COMPUTER USE AGREEMENT

Computer Use Agreement *

I understand and agree that as a member my child will have access to the internet. While precautions are being taken, it is possible that he/she may access inappropriate sites. The Boys and Girl Clubs will have rules and consequences at the Club for such behavior; however we will not be responsible for the consequences of such access. I give permission for my child to use the Boys & Girls Clubs of the Coastal Bend, Technology Program; including but not limited to computers, printers, software, the Internet, database access, and audio-visual equipment/game systems. By signing below, 1 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.

LATE PICKUP FEES

Late Pickup Fees *

I understand and agree that my child (or ward) must be picked up by closing time or a fee of $30 will be charged at six minutes after the regular scheduled time of closure and a $1.00 for each minute afterwards. If my child is not picked up 30 minutes after closing, local authorities may be notified. All fees are expected to by paid prior to my children returning to the Club and to maintain eligibility for after-school transportation service.

NATIONAL PROGRAMS RELEASE

National Programs Release *

I give permission for my child (or ward) to participate in all BGCCB Health and Life Skills Programming, such as, S.M.A.R.T. Moves (Skills Mastery and Resistance Training) a national prevention program that helps young people avoid alcohol, tobacco, other drugs, and teen pregnancy, Street S.M.A.R.T. a national program on gang and violence prevention and conflict resolution, valuing differences and positive peer helpers, S.M.A.R.T. Girls a national program that offers age-specific activities designed to build character and instill the values of integrity, self-discipline and mutual respect and Passport to Manhood a national program that instills in young boys the values and moral compass that will assist them in their journey from adolescence to manhood. I understand that topics of discussion may include physical, emotional and social changes in our bodies, dating and sexual issues such as HIV and other diseases, nutritional habits including eating disorders, healthy exercise, communication skills, taking care of your body, ethics, wellness, respect to authority and employment exploration and careers.

GENERAL MEDIA AND PHOTOGRAPHIC RELEASE

General Media And Photographic Release *

The Boys & Girls Clubs of the Coastal Bend as well as Boys & Girls Clubs of America frequently use photographs information from surveys, and quotes from the members to publicize programs. Your permission is needed to use photos, testimonies, and videos, including information from surveys and/or quotes of your child(ren) on our web site (www.bgccb.org) in informational brochures, social media and in news articles. I give my consent for any photographs or reproductions thereof (while he/she is engaged in Club-related activities) and in which my child(ren) appear or quotes my child(ren) give to be used in anyway the Club may choose including grant/publicity/fundraising purposes.

TRANSPORTATION LIABILITY RELEASE

Transportation Liability Release *

I give permission for my child to ride the Boys & Girls Clubs of the Coastal Bend's bus/van transportation to and from school, home, and 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 Boys & Girls Clubs of the Coastal Bend, 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 acknowledge by signing this form that my child will be eligible to ride the Boys & Girls Clubs vehicles but by not signing, they will not be able to be transported.

After School Travel from School. I authorize transportation service from my child's school to the Club for the current school year. I understand BGCCB reserves the right to remove my child from pick up service. I understand that to remain on the pick-up service, my child must attend 3 or more times a week.
Field Trips/Special Events/Summer Travel. I authorize travel and the BGCCB to any field trip or outing that I sign my child up for during the School Year/Summer Program. I understand that BGCCB reserves the right to remove my child from Club vehicles and/or field trip service.

DATA COLLECTION WAIVER

Data Collection Waiver *

I give permission for the Club to administer occasional anonymous surveys to my child (or ward) via online or written survey, questionnaires, interviews and focus groups, for purposes of better understanding the needs of my child (or ward) and the impact of the Club on my child (or ward). Information will be kept strictly confidential. Data gathered through these means will be summarized in the aggregate and will exclude all references to any individual response. The aggregated results of the analyses may be shared with club staff, BGCA, funders and other community stakeholders to evidence program effectiveness and/or Club impact on our members.

DATA SHARING WAIVER

Data Sharing Waiver *

I understand that the Boys & Girls Clubs of the Coastal Bend share information about my child with Boys & Girls Clubs of America for research purposes and/or to evaluate the program's effectiveness. Information that will be disclosed may include the information provided on this membership application form, information provided by the my child's school or school district, and other information collected by Boys & Girls Clubs of the Coastal Bend including data collected via surveys or questionnaires. All information provided to and from BGCCB will be kept confidential.

SCHOOL INFORMATION

School Information *

I give permission for the Club exchange information regarding my child, to make and retain copies of my child's (or ward's) report cards and/or progress reports or to be given access to school records pertaining to my child (or ward) in order to better understand the academic needs of my child (or ward) and to better assist him/her in his/her educational pursuits. I understand that copies made of report cards and/or progress reports will remain confidential and will only be viewed by Boys & Girls Club staff. I give permission for the Club to obtain age verification of my child (or ward) from their current school.

SWIMMING POOL RELEASE

Swimming Pool Release *

I give consent for my child to use the Club pool (the Club pool is located at the Greenwood Unit). I understand and agree that the Club is not responsible for any bodily injuries incurred and suffered by my child on while in the pool or in the pool area or in connection with any activities at any of its facilities, or while engaged in any Club activities away from the Club.

Choose all that apply: *

My child can swim My child cannot swim My child may take swim lessons None of the above, my child does not have permission to swim

MOVIE USE AGREEMENT

Movie Use Agreement *

I hereby give consent for my child/children to view family movies that are rated "G" OR "PG" that is provided by the Boys & Girls Clubs of the Coastal Bend for specific programming. Movies rated PG-13 are only permitted in the Teen Center with youth ages 13+.

NO REFUND POLICY

No Refund Policy *

I understand and agree that the Club does not refund memberships and/or registration costs. In addition, I understand and agree that my child (or ward) must obey all standards of conduct. I further understand that behavioral problems that cannot be resolved may result in my child (or ward) being suspended from the Club without monetary refund.

GENERAL ACKNOWLEDGMENTS

General Acknowledgments *

I affirm that I have received and will read the Club's Parent/Member Orientation Handbook.

I affirm that I have received and will read the Club's Acceptable-Use Policy/Parent Permission Form.
I have read the competed membership application, all forms in this membership packet and understand the rules of the Boys & Girls Clubs.
I have made available to the Boy & Girls Clubs proof of birth date of my child listed above.

The undersigned represents that he/she is the parent and/or legal guardian of the minor named above, and represents that he/she has the legal authority to execute this consent and release. If the child/applicant is signing for him or herself, the undersigned warrants that he/she has reached the age of legal majority according to the State of Texas.

Electronic Signature (Full Legal Name) *

Program Participation Consent:

The Boys & Girls Clubs of the Coastal Bend offers programs which enhance learning in character & leadership, education and career opportunities, sports, fitness and social development as well as health and life skills. During Program Hours, youth will be asked to participate in program activities. Some activities 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. If you have signed up your child for a field trip and you are NOT able to attend the field trip, or your child has been suspended from a field trip privileges, there will be NO refund.
• Discussion about health issues including sex edu/abstinence & drug resistance, bullying, and peer pressure
• Participation in groups and group processes
• Sharing information with schools about academics, health, behavior and attendance.
• Program participation may include transporting your child to another Boys & Girls Clubs of the Coastal bend facility for a program during our hours of operation. Anything outside our hours of operations will require another consent form to be signed for that particular activity. Member may participate in all Club activities in or adjacent to the Club building

Our Programs include prevention education. These programs strive to educate our members about healthy attitudes & lifestyles. Our programs are designed by separate age groups, 6 & 7, 8 & 9 (May be 8-12 in some cases) & 13-18 years of age. Depending on the age of your child, the program may address some of the following issues: (1) Physical & emotional growth; (2) media influence & body image; (3) eating disorders; (4) personal values & social interaction; (5) the importance of regular health exams; (6) exercise & physical activity; (7) culture & food; (8) healthy habits; (9) food programs; & (10) healthcare connections.

In addition, as part of our programs, we may be administering surveys and pre & post-test to assess our member's knowledge & understanding of some of the topics they learn from in the Boys & Girls Clubs Program Curriculum.

I am giving The Boys & Girls Clubs of the Coastal Bend representatives the ability to make copies of my child's regular school evaluations/report cards, as well as review my child's progress through their online ISO account. (Ex e-chalk or grade-speed) This also grants Boys & Girls Clubs representatives the option to view, record, and copy any of my child's records necessary to assist my child by developing an academic assistance program specific to them, including contacting the school and working with school personnel. The Report Card and Records of my child will be used in connection with our academic mentoring programs targeting the development of my child. (Ex's — Power Hour/Project Learn, Eva Longoria Foundation, SMART Girls, Passport to Manhood and other Boys & Girls Club Programs)

I, as legal guardian of the child(ren) listed on this form, give my permission for them to participate in the program activities mentioned above. All information shared in groups or through questionnaires and surveys will not be linked to my child, as responses will be automatically grouped together with the responses of other Boys & Girls Club members. I understand that if any public presentation of the finding should be made, my child's individual responses will not be linked to him/her or my family. I as the consenting parent/guardian agree to encourage my child and actively participate in the programs. I understand that I can relinquish my permission at any time in writing. I, as the guardian/parent, understand and consent for my child to participate in Boys & Girls Clubs projects, program groups, and activities.

Electronic Signature (Full Legal Name) *

Date (MM/DD/YYYY) *

Sports League Registration

Sports League Information

Participating Sport *

Jersey/Shirt Size *

Youth Information

Name *

First

Last

Gender *

Date of Birth (MM/DD/YYYY) *

Age *

School Name *

Grade of Youth *

Primary Contact Information

Primary Contact Name *

First

Last

Relationship to Youth *

Primary Contact Number *

Primary Contact Email *

Primary Contact Physical Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Information

Emergency Contact Name (Other Than Primary Contact) *

First

Last

Relationship to Youth *

Emergency Contact Number *

Emergency Contact Email *

Statistical Data

Ethnicity *

School Lunch Program *

Single-Parent Household? *

Annual Household Income *

Known Health Concerns

Please list any health concerns BGCCB needs to be aware of during games & practices (i.e. asthma, heart conditions, etc.)

Known Health Concerns (N/A if not applicable) *

Acknowledgment

I approve of my child’s application for membership and/or participation in Boys & Girls Clubs of the Coastal Bend (BGCCB) sports leagues. I will not hold the members of the Board, Staff or Leaders responsible for injury, which may occur while participating in the BGCCB activity mentioned above. I understand that I am responsible for transporting my child to and from events. I also acknowledge that medical insurance is not provided BGCCB.

PLEASE NOTE:
1. Players who have unpaid balance from previous BGC leagues will not be allowed to play until payment is made in full.
2. Sports League fees are NON-REFUNDABLE due to equipment cost, uniforms, Referees, and administrative fees.
3. BGCCB has a NO REFUND policy.

Electronic Signature (Full Legal Name) *

Date (MM/DD/YYYY) *

PARTICIPANT RELEASE OF LIABILITY

Youth's Name *

First

Last

In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that:
The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLI-GENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately, and
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE Boys & Girls Clubs of the Coastal Bend, their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

GENERAL MEDIA & PHOTOGRAPHIC RELEASE
The Boys & Girls Clubs of the Coastal Bend as well as Boys & Girls Clubs of America frequently use photographs information from surveys, and quotes from the members to publicize programs. Your permission is needed to use photos, testimonies, and videos, including information from surveys and/or quotes of your child(ren) on our web site (www.bgccb.org) in informational brochures, social medina and in news articles. I give my consent for any photographs or reproductions thereof (while he/she is engaged in Club-related activities) and in which my child(ren) appear or quotes my child(ren) give to be used in anyway the Club may choose including grant/publicity/fundraising purposes

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE
(UNDER AGE 18 AT TIME OR REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liability incidents to my minor child's involvement or participation in these programs as provided above. EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

The Boys & Girls Club of The Coastal Bend athletics programs provide boys and girls of all ages, regardless of their athletic ability, the opportunity to learn new skills and develop self-esteem, teamwork and leadership skills. Sports programs emphasize fun and full participation for every youth. Coaches and spectators are expected to demonstrate good sportsmanship and positive support for all players and officials.

Electronic Signature (Full Legal Name) *

Date (MM/DD/YYYY) *

Receipt of Parent Handbook Form

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Receipt of Parent Handbook:

I have this day received a copy of The Boys & Girls Clubs of the Coastal Bend Parent Handbook and I understand that l am responsible for reading the policies and practices described within it.

Electronic Signature (Full Legal Name) *

Date (MM/DD/YYYY) *

Submit Membership Application, Sports League Registration, & Receipt of Parent Handbook Form

Submit

Membership Application

Youth Information:

Parent/Guardian Information:

Emergency Contacts:

Household Information:

Parental Authorization:

OPEN DOOR POLICY

PERMISSION TO SIGN OUT

COMPUTER USE AGREEMENT

LATE PICKUP FEES

NATIONAL PROGRAMS RELEASE

GENERAL MEDIA AND PHOTOGRAPHIC RELEASE

TRANSPORTATION LIABILITY RELEASE

DATA COLLECTION WAIVER

DATA SHARING WAIVER

SCHOOL INFORMATION

SWIMMING POOL RELEASE

MOVIE USE AGREEMENT

NO REFUND POLICY

GENERAL ACKNOWLEDGMENTS

Program Participation Consent:

Sports League Information

Youth Information

Primary Contact Information

Emergency Contact Information

Statistical Data

Known Health Concerns

Acknowledgment

PARTICIPANT RELEASE OF LIABILITY

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE
(UNDER AGE 18 AT TIME OR REGISTRATION)

Receipt of Parent Handbook Form

Receipt of Parent Handbook:

Submit Membership Application, Sports League Registration, & Receipt of Parent Handbook Form

Visit Us

What Our Parents Are Saying

Membership Application

Youth Information:

Parent/Guardian Information:

Emergency Contacts:

Household Information:

Parental Authorization:

OPEN DOOR POLICY

PERMISSION TO SIGN OUT

COMPUTER USE AGREEMENT

LATE PICKUP FEES

NATIONAL PROGRAMS RELEASE

GENERAL MEDIA AND PHOTOGRAPHIC RELEASE

TRANSPORTATION LIABILITY RELEASE

DATA COLLECTION WAIVER

DATA SHARING WAIVER

SCHOOL INFORMATION

SWIMMING POOL RELEASE

MOVIE USE AGREEMENT

NO REFUND POLICY

GENERAL ACKNOWLEDGMENTS

Program Participation Consent:

Sports League Information

Youth Information

Primary Contact Information

Emergency Contact Information

Statistical Data

​Known Health Concerns

​Acknowledgment

​PARTICIPANT RELEASE OF LIABILITY

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE(UNDER AGE 18 AT TIME OR REGISTRATION)

Receipt of Parent Handbook Form

Receipt of Parent Handbook:

Submit Membership Application, Sports League Registration, & Receipt of Parent Handbook Form

Visit Us

What Our Parents Are Saying

Known Health Concerns

Acknowledgment

PARTICIPANT RELEASE OF LIABILITY

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE
(UNDER AGE 18 AT TIME OR REGISTRATION)