BOYS & GIRLS CLUB OF ALPENA
YOUTH NAME DATE OF BIRTH________________
ADDRESS STREET CITY STATE ZIP
Preferred first contact (Phone # and Relationship): _________________________________________
Secondary contact (Phone # and Relationship):____________________________________________
List names of individuals (other than primary guardians) authorized to pick up youth. _________________________________________________________________________________________
SCHOOL: AGE: GRADE
HOUSEHOLD: MEMBER LIVES WITH: _______________________________________________
PRIMARY GUARDIAN 1: PRIMARY GUARDIAN 1: WORK NUMBER
PRIMARY GUARDIAN 2: PRIMARY GUARDIAN 2: WORK NUMBER
PRIMARY GUARDIAN EMAIL (OPTIONAL): ____________________________________________________
Have you been a member of this club before? YES OR NO CURRENT OR EX MILITARY: YES OR NO
RULES AND CONSEQUENCES
The rules of the club are simple and easy to follow. The rules follow and may apply to schools, public places, and organizations. The goal of the Boys & Girls Club is to provide a secure and pleasant environment for all of our members and their families. All rules apply to members, guests, and volunteers.
- THE DIRECTION OF THE STAFF MUST BE FOLLOWED FOR YOUR SAFETY. FAILURE TO DO SO WILL RESULT IN LOSS OF MEMBERSHIP.
- STEALING WILL NOT BE TOLERATED. MEMBERSHIP WILL BE REVOKED AND MIGHT NOT BE REINSTATED.
- NO LOUD, ABUSIVE OR OFFENSIVE LANGUAGE. NO FIGHTING, PUSHING, SHOVING OR NAME CALLING.
- NO T-SHIRTS WITH LOGO’S THAT PROMOTE DRUGS, ALCOHOL, ANTI-SOCIAL BEHAVIOR, VULGAR OR OBSCENE LANGUAGE, IMAGES OR REFERENCES. NO GANGS OR BANDANAS.
- NO HATS WORN IN THE CLUB. THIS IS TO SHOW RESPECT. NO MIDRIFF SHIRTS. NO CHAINS OR ARMBANDS. CLOTHING SHOULD BE APPROPRIATE.
- NO HOLDING HANDS, KISSING, OR ANY PHYSICAL CONTACT.
CONSEQUENCES TO RULES
1ST OFFENSE ► VERBAL WARNING
2ND OFFENSE ► PARENT CALL AND STAFF MEETING
3RD OFFENSE ► SUSPENSION FROM THE CLUB FOR A DESIGNATED PERIOD OF TIME
THE POSSESSION OF ALCOHOL, DRUGS OR TOBACCO ON THE CLUB GROUNDS OR THE ACTING OUT OF ANY VIOLENT BEHAVIOR WILL RESULT IN IMMEDIATE SUSPENSION OF CLUB PRIVILEGES AND/OR LOSS OF MEMBERSHIP.
The Boys & Girls Club of Alpena operates under an open door policy. However, we enforce a ‘once you are out, you are out’ policy. Exceptions can be made on an individual basis. All persons entering the club are required to sign in. Visitors must check in with club staff.
Bicycles should be locked and items of value be checked into the office. Please put your name on coats, jackets, and hats. The club is not responsible for lost or stolen items.
If accidents or injury occur, please report to a staff member. An accident form must be filled out and filed in the main office.
All food and beverages are restricted to the tables in the game room only. Please put garbage and empty pop cans in designated containers.
Parent concerns or questions should be directed to a staff member. We hope all club members will conduct themselves in a positive manner not only in the club but also in our community.
My child is allowed to participate in all activities that are in or adjacent to the Club’s property.
We have read the rules and agree to abide by them.
________ Parent Signature Member Signature DATE