Your child has applied for a membership at the Boys & Girls Clubs of Greater Dallas (“Club”). To help us better serve you and your child, please do the following:

1) Read this form in its entirety and explain it to your child.
2) Supply the information requested.
3) Sign this form and return it to the Club facility your child will be attending.

I hereby grant permission for applicant to participate in program activities at the Club. I understand that some of these activities involve sports and field trips, and may take place away from the Club facility. Each time there is a scheduled trip off facility property, I must fill out a Field Trip Permission Form for each instance, water or otherwise. I understand that activities will be supervised by the Club’s staff, but supervision cannot guarantee my child’s safety while he/she participates in these activities. I further understand that some of these activities are potentially dangerous and that the Club cannot, and does not, provide any assurance that my child will not be injured while participating in any activities.

In signing this, I am fully aware that the Boys & Girls Clubs of Greater Dallas program is NOT a licensed child care facility and is NOT regulated by the state.

I also grant permission for my child to walk to the Club from school alone or with a sibling under the age of 18.

By signing this form, I consent to and authorize the use and reproduction by, or as authorized by, the Club, of any and all photographs, videotape, or social media outlets which the Club may take of my child, for any legal purpose whatsoever without any compensation to me or my child. All negatives and positives, together with all prints involving such photographs and any videotape, shall constitute the sole and exclusive property of the club. Also, some information, demographic and otherwise, may be shared with representatives of Boys & Girls Clubs of Greater Dallas and with Boys & Girls Clubs of America.

In executing this form I hereby release the Club, its members, employees, and staff, from any and all claims and causes of action, whether in law or in equity, which may at any time exist as a result of my child’s membership in the Club and his/her participation in Club activities.

By signing here I affirm that my child’s shot records are kept on file at his/her school located on the front of this form.

In executing this form I also agree in the event of emergency illness or accident that a licensed medical doctor shall be authorized to administer medical or surgical treatment deemed necessary for the health or well being of my child. I understand that I will be financially responsible for such care given to my child, and that all reasonable efforts will be made to contact the doctor whose name appears on application before contacting another doctor to treat my child. Boys & Girls Clubs of Greater Dallas reserves the right to deny entry if any member exhibits signs of contagious disease.

Parents are responsible for informing club authorized personnel about health problem and/or concerns.