Afterschool Support

Please list both parents unless one parent does NOT have legal rights to the child. Court Paperwork must be provided to prevent a parent from seeing their child.

Person, other than parent/guardian, who is authorized to pick up member. They MUST have a government issued photo ID when picking up. We will not release members to anyone that is not listed below. Please note that any changes to the pickup list must be done in writing- no phone calls.

1.I request my child be admitted to membership at the Boys & Girls Clubs of Sarasota and DeSoto Counties. It is expressly understood and agreed by the undersigned that the Boys & Girls Clubs of Sarasota and DeSoto Counties is not liable for the loss of property or injury unless such loss or injury results directly from Boys & Girls Clubs of Sarasota and DeSoto Counties negligence or the willful act of an employee of the organization. I also grant the Boys & Girls Clubs of Sarasota and DeSoto Counties permission to authorize and obtain medical care in case of illness and injury when neither parent/guardian is available to grant permission for emergency treatment. I understand that the membership dues are not refundable at any time for any reason. Under the open door policy, it is understood and agreed that all members may come and go, as they desire. Therefore the Boys & Girls Clubs of Sarasota and DeSoto Counties will not be held liable for your child leaving the building and or/grounds. I fully understand and agree to all of the conditions stated on this form and have counseled my child to conform to these rules and the authority of the employees of the organization. I understand that my child’s membership may be suspended or cancelled any time, the sole decision resting in the judgment of the Director. 2. If my contact information (home phone, cell, address, etc.) changes I will let the Boys & Girls Clubs know immediately. This is a very important safety issue. 3. I understand that it is the policy of the Boys & Girls Clubs of Sarasota and DeSoto Counties that my child has their Boys & Girls Club card with them every day. I understand that my child needs this card to check-in and check-out daily. Each child will be given one card when they first sign up. I understand that replacement cards will be at a cost of $5.00. I also understand that it is the policy of the Boys & Girls Clubs of Sarasota and DeSoto Counties that if my child does not bring his/her card that I will be contacted and asked to pick my child up or pay for a replacement card. 4. The Boys & Girls Clubs of Sarasota and DeSoto Counties hours of operation are afterschool- 6pm unless we are open all day when hours are 8am-6pm. During the summer, hours of operation are 8am- 6pm. I also understand that I will incur a late fee of $5.00 if my child is picked up between 1 minute and 15 minutes late and that $1.00 per minute will be charged thereafter. All late fees are due the day of the infraction. If late fees are not paid in a timely fashion I understand this can result in my child’s membership being suspended. 5. I understand that I will be required to attend an orientation before my child can start attending the Boys & Girls Club. An orientation will be scheduled and the parent will be given the date and time. I understand that if I cannot make the orientation that my child cannot start attending the Club until another orientation is rescheduled and attended. This includes any member past or present. 6. The Boys & Girls Clubs of Sarasota and DeSoto Counties has a no nit and no lice policy. If your child is found to have lice or nits they will need to be picked up immediately and may not return until their head is clear of lice and nits. 7. I understand that if the Boys & Girls Club staff contact me regarding my child being sick or hurt that I will pick up my child immediately or make arrangements for them to be picked up. 8. I understand that access to Boys & Girls Clubs’ network and the Internet are designed for educational purposes and the Boys & Girls Clubs have taken precautions to educate members on appropriate educational materials. However, it is understood that no matter how much supervision and monitoring that the Club can utilize, there will always be the possibility of my child coming in contact with inappropriate material, and I will not hold the Boys & Girls Clubs responsible for materials acquired on the network.

I HAVE READ THE COMPLETED APPLICATION AND UNDERSTAND THE RULES OF THE BOYS & GIRLS CLUBS OF SARASOTA AND DESOTO COUNTIES AND REQUEST THAT MY SON/DAUGHTER BE ADMITTED INTO MEMBERSHIP. I HAVE EXPLAINED THE RULES TO MY SON/DAUGHTER AND AGREE THAT THE BOYS & GIRLS CLUBS OF SARASOTA AND DESOTO COUNTIES WILL NOT BE RESPONSIBLE FOR ANY ACCIDENT TO THE BOY/GIRL WHILE ON ANY OF OUR PREMISES OR WHILE ENGAGED IN ANY ACTIVITIES AWAY FROM BOYS & GIRLS CLUBS OF SARASOTA AND DESOTO COUNTIES.