School Year Program

Member to participate in assessments including but not limited to: Surveys for outcome measurements, schools, household demographics, and customized surveys built for specific programs (i.e. SMART Moves). For valuable consideration I, the undersigned, hereby irrevocably consent to and give authorization for my child to participate in Member Assessments used by Boys & Girls Clubs of Sarasota and DeSoto Counties.

Use of Name, Photograph and Identity in Connection with Advertising and/or Promotion of the organization or any of our partners. For valuable consideration I, the undersigned, hereby irrevocably consent to and authorize the unrestricted use by Boys & Girls Clubs of Sarasota and DeSoto Counties/ or partnering agencies of my child’s name, photographs, works of art and identity in various BGCSDC website, social media and collateral material, as well as miscellaneous print publications and other media outlets, and any personal information that I supply to the Companies, in connection with advertising and promotion of the Companies and/or their products in any media, form or material selected by the Companies, without any right of prior review or further approval, whether such advertising and promotion is to the public, to the trade, or both, and in the corporate releases, newsletters and other communications of the Companies; and I hereby waive, and release and discharge said Companies and all agents, employees and officers of the Companies, including their agencies, media producers and customers from, any claims, liabilities and demands, past, present or future, including any that I do not now know of or anticipate arising in the future, none of which would affect my execution of this release if known to me, and waive all rights with respect to such use of my name, photograph, identity, and personal information including but not limited to publicity, privacy, psychological injury and libel.

The Boys & Girls Clubs of Sarasota and DeSoto Counties will maintain all member files in a confidential manner. I give permission for pertinent information (i.e. all academic information, report card information, state testing i.e: FSA or tutorial information) may be shared professionally with Boys & Girls Clubs staff members and Program Partners.

The Boys & Girls Clubs of Sarasota and DeSoto Counties teaches preventative programs called SMART Families & Gang Prevention. Both programs help young people resist the most immediate threat to their wellbeing: premarital sex, alcohol, gang involvement, tobacco and other drugs. The programs are designed to reduce member’s vulnerability by giving them the tools they need to help themselves. The Club also does a bullying prevention program that teaches youth how to not be a bully and what to do if you are being bullied.

I consent that in the event of a medical emergency that my child be given medical treatment at a local hospital, which may include transportation on an ambulance. I also give consent for the Boys & Girls Club staff to act in my absence as guardian of my child in the event of a medical emergency.

The Boys & Girls Clubs of Sarasota and DeSoto Counties will be partnering with the North Sarasota Library to offer our members a variety of exciting programs and activities. We will be walking the members over to the library in a group with staff supervision. I give my child permission to attend activities with Boys & Girls Clubs of Sarasota and DeSoto Counties staff at the North Sarasota Library located across the street from the Newtown Estates Park Boys & Girls Club.