Bishop Woods/Boys and Girls Club of New Haven After-School Program
Bishop Woods and Boys and Girls Club of New Haven Virtual After-School Program
Monday through Thursday from 3:00pm-5:00pm for grades 2nd-8th
Start date November 30, 2020.
Please complete the form to enroll your child in the program.
If you have more than 1 child to enroll, fill out a separate form for each child.
You will be notified by email if you have been enrolled. Maximum 50.
Child's first name *
Child's last name *
Child's address *
Child's birth date *
Child's grade *
Parent First and Last name *
Parent email *
Parent phone number *
PERMISSION FOR ONLINE LEARNING AND ELECTRONIC COMMUNICATION DURING THE PUBLIC HEALTH EMERGENCY A portion of the program may include guest speakers and classes run by BGCNH staff and Yale Student Organizations. They are offering your child the opportunity to participate in online learning sessions through the Boys and Girls Club of New Haven. Program staff will communicate with your child through Zoom or Google Meet. If necessary, program staff may also communicate with your child via email or text. They will copy you on all email or text communications with your child, and your child will not be allowed to participate in the program if you do not provide your email address and cellphone number below. Yale Stuent Organizations include, Yale MedSci, Campus Girl Scout Troop #60630, Yale Moneythink, Word: Performance Poetry, Yale CityStep, and Mindful Exchanges at Yale *
PERMISSION TO USE IMAGES AND RECORDINGS OF YOUR CHILD AND HIS OR HER WORK During the course of the Boys and Girls Club of New Haven online learning program (“the Program”), registered Yale Student Organizations* may use photographs, videos, films, or other media to record or otherwise capture your child’s image or voice or material resulting from his or her activities or performances (collectively, “Images and Recordings”). As described below, this form allows Yale University and its contractors, agents, and licensees (“Yale”) to use those Images and Recordings.In exchange for Yale allowing your child to participate in the Program, you agree to the following:1. You grant to Yale the permanent right to use the Images and Recordings in all types of media in connection with the Program and for other purposes that support Yale’s not-for-profit mission. This permission includes use of the Images and Recordings in any new types of media that might be developed in the future.2. Neither you nor anyone else acting on behalf of your child will have any right to approve or be paid for Yale’s use of the Images and Recordings.3. Neither you nor anyone else acting on behalf of your child will have any right to make a legal claim as a result of Yale’s use of the Images and Recordings, and any such claim is covered by the “Assumption of Risk, Release from Liability and Indemnification” that you have signed. *
Assumption of Risk, Release from Liability and Indemnification. My child is not yet 18-years-old and will participate in online learning sessions through the Boys and Girls Club of New Haven, which includes instructional time featuring registered Yale Student Organizations*. This document (“Agreement”) covers all aspects of my child’s participation in the Program. In this Agreement, “Yale” means Yale, its trustees, officers, employees, trainees, students, volunteers, agents, and student organizations*.1. Program Risks. I understand that participation in the Program involves risks that Yale cannot eliminate, including, among others, risk of property damage, illness, bodily injury, permanent disability, and death.2. Assumption of Risk. I voluntarily take responsibility for all risks of participating in the Program.3. Release. In exchange for Yale allowing my child to participate in the Program, I release Yale from all legal and financial responsibility for any harm that I, my child, or our property might suffer as a result of my child’s participation, even if the harm is caused by Yale’s negligence.4. Indemnification. I agree to indemnify and hold Yale harmless from (that is to say, I agree to pay or reimburse Yale for) any costs, penalties, legal fees, or judgments (“Costs”) that Yale has to pay related to my child’s participation in the Program, even if the Costs resulted from Yale’s negligence.5. Governing Law and Jurisdiction. The laws of Connecticut shall govern and the courts of Connecticut shall interpret this Agreement.6. Binding Agreement. This Agreement shall legally bind me, and my child, family members, spouse, estate, heirs, administrators, or personal representatives.7. Severability. If a court decides that any part of this Agreement cannot be enforced, I agree to change that part to make it enforceable. If the unenforceable part cannot legally be changed, it will be severed, but the rest of the Agreement will remain in effect.8. Signature. I agree that I have read and understood this Agreement, I am competent to sign it, and I do so voluntarily and without relying on anything Yale wrote or told me except what is written above. I understand that I am free not to sign this Agreement and to find a different program for my child. My name below will act as my electronic signature. *
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