Summer Camp Registration Page

Data Collection

I give my permission to Country Club Outreach Center to collect information via Online or written surveys, questionnaires. interviews. and focus groups from the minor child listed on this application. Any and all information received will be kept strictly confidential. Data gathered through these means will be summarized in the aggregate and will exclude all references to any individual responses. The aggregated results of these analysis may be shared with Outreach Center Leaders, funders, and other community stakeholders to evidence program effectiveness and/or Center impact on our members.

Data Sharing

I understand that Country Club Outreach Center may share information about the minor child listed on this application with Boys & Girls Club of Cumberland County for research purposes and/or to evaluate the program’s effectiveness. Information that will be disclosed to Boys & Girls Club of Cumberland County may include the information provided on this membership application form, information provided by the minor child’s school or school district, and other information collected by Country Club Community Outreach Center, including data collected via surveys or questionnaires. All information provided to Boys & Girls Club of Cumberland County will be kept confidential.

Safe Passage Policy

The Center has a Safe Passage Policy, which allows Center members to attend at any time during operating hours unless otherwise posted.

Under this policy:

• Members must sign in and out each day;
• Members under the age of 13 must be retrieved from the Outreach Center by a parent, guardian, or other authorized adult;
• Members age 13 and older may leave the center unescorted with written permission from a parent or guardian and a signed release of liability;
• Members age 13 and older may also escort other members of their household from the Center with written permission;
• No member, regardless of age, will be allowed to return to the Center once they leave the premises for the day; except for doctor appointments or if approved by the Outreach Center Director;
• Members that leave unescorted without written permission will face disciplinary actions up to and including suspension and termination of membership.

Country Club Outreach Center Programs

I understand the priority the Center places on academic success, healthy lifestyles, and good character and citizenship and therefore support my child’s participation in the Center’s core program such as: Power Hour, Street SMART, Triple Play, etc.., My child is also given a permission to participate in SMART Moves at the Center. These programs address problems such as drug and alcohol use. The program uses a team approach involving the Center’s staff, peer leaders, parents and community representatives. We understand the sensitive nature of the programming may not fit every family, however, please keep in mind that the curriculum is very age appropriate. The delivery of this program is very important to your child’s development and to the funding of our Center, as it is directly tied to grant funding that supports overall program delivery.

School Records

I give my consent to the Country Club Community Outreach Center to obtain information from my child’s school (ex. report card, grade point average, disciplinary records, and the number of days absent). This data is used for grant reporting to ensure continued funding for the Center’s programming and for use in evaluating program effectiveness. This information will be confidentially secured for a minimum of five (5) years.

Media Permission

For valuable consideration I, the undersigned, hereby irrevocably consent to and authorize the unrestricted use by Country Club Community Outreach Center, affiliates and advertising agencies of my child’s name, photographs, works of art and identity in various Outreach Center website 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 for the companies and/or their products in any media, form or material selected by the companies, without any right to prior review or further approval. Whether such advertising and promotion is to the public, to the trade, or both, and in the corporate releases, newsletter, and other communications of the companies, and I hereby waive, release, and discharge said companies and all agents, employees and officers of the companies, including their agencies, media producers and customers from any claims, liability, and demands, past, present, or future, including any that I do not 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.

Computer and Internet Use Permission

All computer systems are the property of the Country Club Community Outreach Center and are for authorized use only. Users have no explicit or implicit expectation of privacy. Any or all uses of a computer and all files on the computer may be intercepted, monitored, recorded, copied, audited, inspected, and disclosed to authorized personnel, as well as authorized officials of other agencies. By using a computer, the user consents to the terms stated above.

Unauthorized or improper use of a computer may result in administrative disciplinary action and civil and criminal penalties. By using a computer, you indicate your awareness of and consent to these terms and conditions of use.

If you do not agree to the conditions stated in this warning, your camper WILL NOT be allowed to use a computer.