Your child has applied for a membership at the Boys & Girls Clubs of Greater Dallas (“Club”). To help us better serve you and your child, please do the following:

1) Read this form in its entirety and explain it to your child.
2) Supply the information requested.
3) Sign this form and return it to the Club facility your child will be attending.

I hereby grant permission for applicant to participate in program activities at the Club. I understand that some of these activities involve sports and field trips, and may take place away from the Club facility. Each time there is a scheduled trip off facility property, I must fill out a Field Trip Permission Form for each instance, water or otherwise. I understand that activities will be supervised by the Club’s staff, but supervision cannot guarantee my child’s safety while he/she participates in these activities. I further understand that some of these activities are potentially dangerous and that the Club cannot, and does not, provide any assurance that my child will not be injured while participating in any activities.

In signing this, I am fully aware that the Boys & Girls Clubs of Greater Dallas program is NOT a licensed child care facility and is NOT regulated by the state.

I also grant permission for my child to walk to the Club from school alone or with a sibling under the age of 18.

By signing this form, I consent to and authorize the use and reproduction by, or as authorized by, the Club, of any and all photographs, videotape, or social media outlets which the Club may take of my child, for any legal purpose whatsoever without any compensation to me or my child. All negatives and positives, together with all prints involving such photographs and any videotape, shall constitute the sole and exclusive property of the club. Also, some information, demographic and otherwise, may be shared with representatives of Boys & Girls Clubs of Greater Dallas and with Boys & Girls Clubs of America.

In executing this form I hereby release the Club, its members, employees, and staff, from any and all claims and causes of action, whether in law or in equity, which may at any time exist as a result of my child’s membership in the Club and his/her participation in Club activities.

By signing here I affirm that my child’s shot records are kept on file at his/her school located on the front of this form.

In executing this form I also agree in the event of emergency illness or accident that a licensed medical doctor shall be authorized to administer medical or surgical treatment deemed necessary for the health or well being of my child. I understand that I will be financially responsible for such care given to my child, and that all reasonable efforts will be made to contact the doctor whose name appears on application before contacting another doctor to treat my child. Boys & Girls Clubs of Greater Dallas reserves the right to deny entry if any member exhibits signs of contagious disease.

Parents are responsible for informing club authorized personnel about health problem and/or concerns.

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Boys & Girls Clubs of Greater Dallas has put in place preventative measures to reduce the spread of COVID-19; however, the Club cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Club could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Club and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the Club or participation in Club programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.