BCYF Snap Shot Application 2019
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E-posta *
First Name *
Last Name *
Date of Birth *
GG
/
AA
/
YYYY
Address *
Home Phone *
Cell Phone *
School *
Type of School *
Grade *
What is your T-shirt size? *
Adult sizes
Who do you live with? *
Ethnicity
Do you have any medical conditions or allergies we should be aware of? *
If yes, please explain.
Parent/Guardian Name *
Parent/Guardian Cell Phone Number *
Parent/Guardian Work Phone Number *
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 *
What interests you most about this program and what do you hope to gain from participating in the Snap Shot Program this summer?   *
Please tell us about any experience or special interest you have with photography or the arts: *
Do you have additional work or volunteer experience? Please specify. *
How did you hear about this position?  If you were referred, who referred you? *
References
Please list two (2) non-family adult references (example: teacher, community center youth worker, coach, etc.)

Reference 1 Name *
Reference 1 Name *
R1 - How long have you known this person? *
R1 - How do you known this person? *
R1 - Phone *
R1 - Email *
Reference 2 Name *
R2 - How long have you known this person? *
R2 - How do you known this person? *
R2 - Phone *
R2 - Email *
I will be able to attend the entire program. *
Consent
I have read and understand the BCYF Code of Conduct and the BCYF Pool Rules and Regulations.  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.
Signature
Please type your name to indicate you have read the above consent. If you are selected to participate in this program additional documents will be provided for signing by both you and your parent/guardian.
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