salembgc.org

Please include requested information. Thank You.

REMINDER!: Your child's membership registration must be completed prior to registering for camp.

SUMMER CAMP REGISTRATION INFO:

Please verify the weeks you are signing up for:

SURVEYS, IDENTIFICATION, POLICIES, AND WAIVER/RELEASE OF LIABILITY This field is mandatory. As a requirement of membership, I, the parent/guardian of the minor child listed on this application, give permission for Boys & Girls Club of Salem to survey my child about his or her Club experience, behaviors, skills and attitudes using Boys & Girls Clubs of America’s National Outcomes Survey or other survey instruments. This information may be shared with Boys & Girls Clubs of America. MEMBERSHIP IDENTIFICATION CARD POLICY: All members (who are issued a card) must scan their membership identification card upon entry to the facility and for program participation as requested by staff. A $5 fee will be assessed to acquire an additional or new card. WAIVER/RELEASE OF LIABILITY I have read the completed application including all policies; understand the rules of the Boys & Girls Club of Salem and request that my son/daughter be admitted into membership or preschool/child care. I have explained the rules to my son/daughter and agree that the Boys & Girls Club of Salem will not be responsible for any accident to my son/daughter while on the premises or while engaged in any Club activities away from the Boys & Girls Club of Salem. I give my consent to his or her being given a physical exam or treatment by a physician or hospital in case of emergency. I am responsible for any changes to the information provided on this form. Program fees may be adjusted without notice; membership fees are not transferable or refundable. I also consent to the use of photographs/images of my child (newspapers, brochures, videos, etc.) and give permission for my son/daughter to use the internet, computers, & technology. BY CLICKING SEND TO SUBMIT THIS FORM I HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE THE GREATER SALEM BOYS & GIRLS CLUB, ITS BOARD, VOLUNTEERS, EMPLOYEES OR STAFF OR ANY AGENT THEREOF, OR ANY OWNERS AND LESSEES OF PREMISES USED TO CONDUCT ANY EVENT, ACTIVITY, SPORTING EVENT OR CONTEST SPONSORED BY THE CLUB, ALL FOR THE PURPOSES HEREIN REFERRED TO AS THE “RELEASEES,” FROM ALL LIABILITY to the undersigned for any bodily injury, all loss or damage, and any claim or demands therefore on account of injury to the person of the undersigned, whether caused by the negligence of the “Releasees” or otherwise while the undersigned is in the Club, or participating in any Club game, practice, or sporting event. 2. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS THE “RELEASEES” from any loss, liability, damage, or cost they may incur due to the Member’s participation in any sporting event, game or practice or in any way competing, officiating, observing, or for any purpose participating at any time in the event and whether caused by the negligence of the “Releasees” or otherwise. 3. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY DUE TO THE NEGLIGENCE OF “RELEASEES” OR OTHERWISE while in the Club or while engaged in any Club activity, game, practice or other event on the premises or while engaged in any Club activities away from the Boys & Girls Club of Salem. I acknowledge and agree that club activities may involve a risk of serious injury and I have read this release. This is a release of liability. I have had the opportunity to read this release and to consult with an attorney before submitting this form.

Text Verification