Virtual Programming for Club Members- Consent Form
Dear Parent/Guardian:

In an effort to continuously serve members during the Club closure, Boys & Girls Clubs of Carson is providing distance-based, virtual programming for Club members, through which Club staff will facilitate program activities through online platforms. Boys & Girls Clubs of Carson will use software, tools and 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.

This letter seeks consent for your child to utilize these online applications for distance-based, virtual Club program purposes. Please be aware that each application collects different information about its users and has its own privacy terms and conditions to which members must adhere. This program is sponsored by the Boys & Girls Clubs of Carson and not by the Los Angeles Unified School District (LAUSD).

Please review all privacy terms and conditions carefully before registering your member:

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In order to participate in virtual Club programming, you need to provide the following:

•A computer, 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

We will use the online applications for the following program activities:

•Video conferencing, virtual programming, virtual mentoring

Our commitment to keeping the young people we serve safe is always our number one priority. Boys & Girls Clubs of Carson will actively monitor member activity on any online applications 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; limiting the purposes for which the online platforms may use member information; ensuring there is no advertising and that no member information is collected for commercial purposes.

Further, all activities online must comply with Boys & Girls Clubs of Carson’s safety policies, including the Code of Conduct, Technology Usage Policy, Social Media Policy, and Child Safety Reporting Policy. These policies prohibit our staff engaging in the following:

•1:1 communicating with members, in writing, by phone/email/electronically, via Internet or in person at any time.
•Calling members at home or on their cell phone, except for specific program-related purposes and/or situations.
•Providing members with a personal home/cell telephone number, personal email address, home address or other personal contact information, except for specific program-related purposes and/or situation.
•Interacting with any members using social media.
•1:1 virtual programming, video or chat-based activity involving members
•Virtual activities with less than a minimum of 3 youth participants in any group programming.

Please complete the attached form to record your consent for your child’s use of these online applications.

 If you have any questions, please feel free to contact me.


Sharon Ramos
VP of Operations

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Youth First Name *
Youth Last Name *
Youth Age *
Youth Date of Birth *
In your household, are there currently other youth involved in our BGCC programs? If so, please write their full names below.
School Youth Attends *
Parent/Guardian Full Name *
Parent/Guardian Phone Number *
Parent/Guardian Email *
By clicking the button below, you are consenting as the parent or guardian of the youth listed above to give permission for him/her to participate in distance-based online Club experiences at Boys & Girls Clubs of Carson. *
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