This form is required for your child to participate in Club programming. Please take your time to complete the form in its entirety so that we have emergency contact information on file while your child is in our care. You must complete a separate registration form for each child you wish to enroll.

Boys & Girls Club of the Tri-County Area (BGC) Authorization: I understand the rules of BGC and I request that my child be admitted into membership. I have explained the rules to my child. I understand the hours of operation of BGC and that additional charges may be assessed if I pick up my child after these hours. I hereby give permission for the participant listed on this application to take part in BGC activities, which may include off-site events,  OJJDP mentoring, academic assistance, continuing education and recreational programs. BGC may freely transport my child within the confines of the Berlin, Green Lake, and/or Ripon area without further permission.

If a medical emergency arises, BGC will take all steps necessary to ensure the safety of the participant. If necessary, BGC will call a public emergency vehicle for transport to an emergency facility. I understand that I will be responsible for any transportation charges and medical expenses incurred. The participant is releasing the operator for any acts of negligence or its negligent acts. The participant assumes all risk associated with negligent acts of either BGC or the participant. The participant cannot release willful, wanton, or intentional acts done with reckless disregard of the natural and probable consequence of injury. Additionally, I hereby give my consent for emergency medical care or treatment to be used only if I cannot be reached immediately.

I give my consent to BGC to take the participant’s photograph during program activities, to be used for education, public relations and marketing purposes. I further give my consent to the school and BGC to share the participant’s student records with each other for purpose of providing educational support and assistance. In addition, I understand that the school district and BGC will use participant records to evaluate individual progress and improvement, as well as to evaluate the impact of Club programs on student achievement and to obtain continued funding for the program.