BGCHarlem Virtual Learning Parent Consent Form
In an effort to continuously serve members during the Club and School closure, the Boys & Girls Club of Harlem is providing distance-based Club experiences through which Club staff will facilitate program activities through an online platform. The Boys & Girls Club of Harlem will use applications provided by third parties that members, parents/guardians, and/or staff will access via the Internet and use for purposes of communication and programming. These platforms are called Google and Zoom.

This form seeks consent for your child to utilize Google and Zoom for distance-based Club program purposes. Both Google and Zoom provide an opportunity to deliver video and chat-based educational experiences to members via any device on Google Meets/Classroom. Please be aware that Google/Zoom collects information about its users and has its own privacy terms and conditions to which members must adhere. Please review Google’s privacy terms and conditions carefully before registering your member: and Zoom's privacy and terms of conditions here: and

In order to participate in distance-based Club experiences, you will need to provide the following:
A computer, mobile, or tablet device with access to the Internet
A quiet space at home in which members can participate in distance-based experiences under the supervision of an adult
To register for Zoom, you will need to provide some customer data, including but not limited to:  your email address and first and last name (for more information, see  

We will use Google/Zoom for the following anticipated program activities:
Group chats
Video conferencing
Media sharing (for example, uploading images of artwork or other projects)  

Our commitment to keeping the young people we serve safe is always our number one priority. The Boys & Girls Club of Harlem will actively monitor member activity on Google/Zoom and will make every effort to protect member information by, among other things, maintaining control of, and access to, the data collected; prohibiting re-disclosure of member information; and limiting the purposes for which the online platforms may use member information.

Be advised, by participating in our virtual program, you are granting permission for your child’s image and likeness to be filmed, photographed, edited, copied, exhibited, published, or distributed by the Boys and Girls Club of Harlem. If you do not wish for your child to be photographed and/or filmed, please share below or inform the Boys and Girls of Harlem staff immediately.

Further, all activities online must comply with Boys & Girls Clubs of America’s safety policies, which are available:

Please complete this form to record your consent for your child’s use of the Google and Zoom platform.

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Email *
Do you give your child permission for him/her to participate in distance-based online Club experiences at the Boys & Girls Clubs of Harlem? *
Parent/Guardian Signature *
What is the name of the child participating? *
Is there another email address that you would prefer we use to communicate with you about our virtual program?
What school does your child attend?
How did you hear about this opportunity?
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Thank you for joining our online community! In the next few days, you will receive an email with information regarding our virtual program i.e. schedule and class offerings. Please share any questions, concerns, or comments about this platform below:
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