Teen House Participant Agreement and Contact Info

The JCC Teen House, located at 6705 Hoover Road, is a safe place for middle schoolers and teens to gather after school, on school breaks, and for special programs and events. The Teen House is open Mon-Fri from 3:30pm - 6pm. All children must register with this form to be able to visit the teen house daily. Please contact Kenny Lambert (klambert@jccindy.org) if you have any questions, comments, or concerns.

    Participant Info

    Please use the following section to provide basic information about you child that will be visiting the teen house. Households with multiple children must submit this form for each child individually.
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    Parent Info

    Please complete the following section with full contact info for at least 1 parent per household.
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    Participation Agreement

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    Emergency Contact

    In the case that neither parent can be reached, please provide an alternate contact person that you authorize us to speak with about your child during an emergency situation.
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    Help the Teen House Remain the Teen House!

    After-school programming at the JCC Teen House is currently offered as a free program to the youth of our community. In order to help maintain this valuable service, please consider pledging a donation to help keep this program running! From smaller expenses like cable and internet, to large expenses like additional staffing and capital improvements to the property (new fence in backyard, new carpet, and new furniture) every dollar helps!
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    Confirmation

    I/We, the parents or legal guardians of the previously named child, attest that all information provided in this form is true and accurate to the best of my/our knowledge. I/We understand all rules, regulations, and general policies of the Teen House and the JCC and have discussed these rules, regulations, and policies with my/our child and he/she is fully aware of these rules, regulations, and policies and the possible disciplinary action that may result in disobeying them.
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