Membership Application

A parent/guardian MUST attend orientation to receive your permenant Membership card. Please see our staff at the front desk for a list of upcoming orientation days and times.

Emergency Contact (MUST be filled out prior to membership)

Medical Information (if none, please indicate with N/A)

LATE FEE POLICY

You agree to pick up your child by the posted closing time. A late pick-up fee of $10.00 per child will be assessed 5 minutes after the posted closing time. There will be an additional charge of $1.00 per child per minute starting 10 minutes after the posted closing time. If there is no contact from the parent/guardian and no other safe option 20 minutes after closing time, your child will be turned over to the city or county police department. Your child cannot return until the late fee is paid in full.  I acknowledge the above Late Fee Policy and agree to the terms above. 

MEMBER PLEDGE PRINCIPLES

I will give my best effort in all Club activities, treat others respectfully and through my positive behavior, promote a sense of fair play, honesty, and good sportsmanship. I will not allow anyone else to use my membership privileges. If at any time I am suspended from attending the Club, I will return my membership card, forfeiting all Club privileges. I understand that all membership fees are not refundable. I understand that the Boys & Girls Club of Lansing is not responsible for any lost, stolen, or damaged property. 

I agree to uphold the Member Pledge Principles: 

PARENTS/GUARDIANS: PLEASE CHECK YES or NO

I grant the Boys & Girls Clubs of Lansing permission to:

ABOVE PERMISSIONS: Videos and photos of members can be used for Club promotions. Guardians will receive notice in advance of field trips. The reason to contact school would be for receiving or sending progress reports. Surveys would be used to assess youth needs, typically with program needs. 

WAIVER OF DISABILITY AND DISCLAIMER: In consideration of my child’s membership and participation in the activities and program of Boys & Girls Club of Lansing, I, as parent or guardian of named minor, my heirs, executors, administrators and assigns, waive, release, and discharge any and all rights and claims or damages against the Club and/or its sponsors for knowledge of the risks involved in said participation and that my child is in good health and has no physical or mental condition which would make it dangerous for my child or for other participants when my child is involved in any of the sponsored activities. 

EMERGENCY AUTHORIZATION: I hereby give permission to medical personnel selected by Boys & Girls Club of Lansing, its employees, agents, directors, volunteers, or sponsors to provide or seek emergency treatment, (including x-rays) for my child in the event I cannot be reached in an emergency. However, the giving of my permission does not obligate Boys & Girls Clubs, its employees, agents, directors, volunteers, or sponsors to arrange such care except as may be directed by medical personnel. 

OPEN DOOR POLICY: I understand that Boys & Girls Clubs of Lansing is an open door facility and open to all youth members during posted hours of operation. My child will be supervised while at the Club. I set the boundaries and consequences if my child leaves the facility without my permission. 

I certify that the information concerning the applicant is accurate:

All information requested on our membership application is kept strictly confidential. Free/reduced lunch status and race/ethnic background information is required and only used for grant funding and reporting purposes.