BCYF Adventure Girls Wait List Application 2019

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The BCYF Adventure Girls program has reached it's capacity for Summer 2019 however, a wait list has been started. Should spots become available they will be filled on a first come - first serve basis.

About: The BCYF Adventure Girls program is for Boston girls ages 9-12. Adventure Girls 2019 begins Monday, July 22, 2019 and runs through Thursday, August 15, 2019 from 11 a.m. - 3 p.m. for four weeks.

Email *

Participant First Name *

Participant Last Name *

Date of Birth *

YYYY

Address *

Home Phone *

School *

Type of School *

Grade *

Participant T-shirt Size *

Participant lives with *

Participant ethnicity

Does the participant have any medical conditions or allergies we should be aware of? *

Yes

If yes, please explain.

Parent/Guardian Name *

Parent/Guardian Cell Phone Number *

Parent/Guardian Work Phone Number *

Parent/Guardian Address (if different from participant)

Parent/Guardian Name

Parent/Guardian Cell Phone Number

Parent/Guardian Work Phone Number

Parent/Guardian Home Phone Number

Parent/Guardian Email

Parent/Guardian Address (if different from participant)

Emergency Contact Name *

Emergency Contact Cell Phone Number *

Emergency Contact Work Phone Number *

Emergency Contact Home Phone Number *

Emergency Contact Address *

Consent

I have read and understand the BCYF Code of Conduct and the BCYF Pool Rules and Regulations (bit.ly/BCYFcodeofconduct). I agree that I will act in accordance with the BCYF Code of Conduct and abide by BCYF’s Pool Rules and Regulations.

The application is factual and complete to the best of my ability.

I hereby waive and release any and all rights, causes of action, and claims for damages I may have against the City of Boston, Boston Centers for Youth & Families (BCYF), and any and all other associated individuals or organizations, for any and all personal injuries or property damage resulting from my participation in BCYF Programs.

I, the undersigned parent or guardian of the listed participant, a minor, hereby consent to his/her BCYF membership and waive and release any and all rights, causes of action and claims for damages I may have against the City of Boston, BCYF, and any and all other associated individuals or organizations, arising out of any and all personal injuries or property damage which I may now or hereafter have as the parent or guardian of said minor, and also all rights, causes of action, and claims which said minor has or may acquire resulting from his/her participation in the program.

I give consent for me/my child to be administered first aid and to be treated by an emergency medical technician-paramedic, nurse or physician. Any follow up medical attention may be given at a local hospital and transportation to a Boston hospital is authorized. I give my consent for photographs, audiotapes, and video records of me/my child to be used by BCYF for publicity purposes. I also agree to allow BCYF to use photographs, audiotapes, video records or other work produced by the member for publicity purposes.

I understand that transportation is not provided and it is my responsibility to arrange transportation to and from BCYF Community Centers and programs.

Failure to comply with these rules and expectations can lead to termination of membership.

The participant will be able to attend the entire program.

Yes

Clear selection

Parent Signature

A copy of your responses will be emailed to the address you provided.

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