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Teen Program at the Albany Clubhouse
Boys & Girls Clubs of the Capital Area, 21 Delaware Ave, Albany NY
Serving teens 13-19 / Mon-Fri 3-8pm
David Gordon, Program Manager
518.462.5528 x1013 /
dgordon@bgccapitalarea.org
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Teen Name
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Your answer
Address
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Teen phone
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Your answer
Teen Email Address
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Your answer
Parent/Guardian Name
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Your answer
Parent/Guardian Phone
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Your answer
Emergency Contact Name
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Your answer
Emergency Contact Phone
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Your answer
It is hereby understood: (Must check all boxes)
*
Permission is granted from parent/guardian for teen to participate in the Teen Program
BGCCA provides a clean and safe environment with ZERO TOLERANCE for fighting, bullying or disrespect
The Club and surrounding property is a smoke and drug-free zone
Parent/guardian will be held responsible for any theft or damage to Club property
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