Request edit access
Parent/Guardian Intake Form
The following form is for Parents/Guardians of youth attending programs at OUTright Youth of Catawba Valley's center. It includes basic information, how best to contact parents/guardians, emergency contact information, any relevant medical/allergy information about the youth, and permission to photograph/video the youth, as well as permission to add the youth to our private Discord server.

If the center is ever closed or a program is canceled, you will be contacted using the information below. If there is an emergency on the premises, we will contact the emergency contact below.

If you have any questions or concerns, please email Rachael Woodard, Program Director, at programs@outrightyouthcv.org

The following rules have been implemented at the OUTright Youth Center:

OUTright Youth Rules/Norms


  1. Respect the space and each other

    1. No throwing things at each other

    2. No running/horseplay

    3. No defacing property (artwork, stickers, paint, etc.)

    4. Be courteous and attentive with our guests. They are professionals who volunteer their time and talents to come share with us.

    5. Remain in our center during group and exit only through front doors (do not access back doors or alarm will go off)

  2. Keep discussions PG rated

  3. No outing, ever. What happens at ORY stays at ORY and is private

  4. Call and Response: There will be a call and response each week with the activity leader(s). If you hear the call, respond immediately by paying attention and responding with the dedicated response, then remaining quiet and attentive. (Example: call - “Who lives in a pineapple under the sea?” response - “SPONGEBOB SQUAREPANTS”)

  5. Speak for yourself - use “I” statements whenever possible in discussions. Everyone is different and deserves to have their opinion and experiences heard and understood.

  6. No social media connections between staff/volunteers and youth, except for our private Discord server. See Rachael to join our Discord server, with parents’ permission.

  7. Adult supervision is required at all times except for using the restroom, and ONLY ONE PERSON IN THE RESTROOM AT A TIME. No exceptions. 

    1. During a private discussion with an adult, another adult should be present as a witness.

    2. During group, youth must remain in line of sight to at least 1 adult at all times (except when using the restroom or in quiet room)

  8. Quiet Room: 1 person per quiet room, no exceptions. If an adult is needed in the quiet room, 2 adults must be present with the youth.

  9. No PDA. This is a youth center for fellowship, not a place for dating. Please respect each other and each person’s personal space.

  10. Cleanup: ALL staff, volunteers, and youth must participate in cleanup at the end of each group:

    1. Recyclable plastic, glass, and cans should all go in the sink to be rinsed and dried. If you are unsure what is recyclable, ask an adult. Cardboard and paper should go directly in the recycling bins.

    2. Trash Sweep: Everyone is responsible for the space. When cleanup time is announced, please do a sweep for trash/recyclables in your immediate area (within 10 foot radius). 

    3. Put away whatever you have gotten out. If you are using craft supplies for a group activity, help the staff/volunteers put away the supplies. 

    4. Cleaning surfaces: please wipe down tables and countertops that have been used during group with antibacterial wipes.

  11. Vacuuming: One adult should vacuum the floors after each group.

  12. If you need help with anything, including understanding these rules, ask an adult, particularly the Program Director or Executive Director.

  13. Failure to follow these rules will result in a call for parent/guardian to immediately pick you up and you will be restricted from attending the following week. Continued failures to follow the rules will result in being uninvited to the group for the foreseeable future.

Sign in to Google to save your progress. Learn more
Email *
Youth Name *
Parent/Guardian #1 Name *
Parent/Guardian #1 Email Address *
Parent/Guardian #1 Phone Number *
Parent/Guardian #1 Mailing Address *
Parent/Guardian #1 Physical Address (If different from above) *
Do we have permission to contact Parent/Guardian #1 via the following? (Check all that apply) *
Required
What is the best way to communicate with Parent/Guardian #1? *
Parent/Guardian #2 Name
Parent/Guardian #2 Email
Parent/Guardian #2 Phone Number
Parent/Guardian #2 Mailing Address (If different from above)
Parent/Guardian #2 Physical Address (If different from above)
Do we have permission to contact Parent/Guardian #2 via the following? (Check all that apply)
What is the best way to communicate with Parent/Guardian #2?
Clear selection
Does your child have any allergies or medical conditions that may affect their time at ORY? If so, please list them here. *
Do the above allergies/medical conditions require medication? If so, please list any medications they may need access to here.
Name of Emergency contact for youth while at ORY *
Emergency Contact Phone Number *
Do you consent to your child being photographed or recorded while at the ORY center, exclusively for use by ORY? These might be shared on our website, social media, and other outlets for promotional or grant proposal purposes. *
Do you agree to your child joining the ORY private Discord server? Only youth and staff have access to it, there is no private messaging except to staff, and posts include what we are doing for programs every week, as well as community resources from other groups. Our server is highly monitored by staff and any violation of the rules will be met by being banned from the server. *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of OUTright Youth of Catawba Valley.

Does this form look suspicious? Report

Google Forms