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  • JUNIOR REGISTRATION

  • OPENING DAY

    BCNY’s Fall 2021 afterschool program starts on Tuesday, October 12th.

    SCHOOL HOLIDAY CLOSURES

    BCNY is closed when NYC public schools are closed. Please view the BCNY calendar included with this form. For closures due to inclement weather, please be on the lookout for messages from BCNY.

    ELIGIBLE AGES

    Members must be currently enrolled in 6th, 7th, and 8th grade to be eligible to register for membership at Abbe Clubhouse and Gerry Clubhouse.

    REQUIRED REGISTRATION DOCUMENTS

    • Birth Certificate/Passport (a photocopy is acceptable)
    • Updated Immunization Records OR New York Dept. of Education “Medical Request for Immunization Exemption” Form
    • Proof of COVID Vaccination for Members age 12 or over
    • CACFP Food Form
    • Physical Examination Form (signed, dated in 2021 or later, and stamped) 

    ATTENDANCE POLICY

    Registered members are expected to attend BCNY a minimum of 3 days a week. Members who cannot meet these expectations may have their membership reviewed or suspended.

    WAITLIST

    Please note that space is limited. Registration is on a first-come, first- served basis. If registration is full, your child will be placed on a waitlist.

    ABBE CLUBHOUSE: 133-01 41st Road, Flushing, New York 11355 718.886.5454

    GERRYCLUBHOUSE: 321 East 111th Street New York, NY 10029 212.534.2661

  • MEMBER INFORMATION

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  • MEMBER'S EDUCATION

  • Primary Parent/Guardian Information

  • SECONDARY PARENT/GUARDIAN INFORMATION

  • EMERGENCY CONTACTS

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  • MEMBER'S HEALTH INFORMATION

  • HOUSEHOLD INFORMATION

    Note: The information will remain completely confidential
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  • PARENT AND MEMBER CONSENT

    (required for all. Legal guardian or parent must sign. Members 18 and over must sign themselves)

    I have read the completed application; I understand the rules of The Boys' Club of New York [BCNY] and I request that the proposed member be admitted. On his behalf I hereby release, discharge. indemnify and hold harmless The Boys' Club of New York, and any of its affiliates, subsidiaries, officers, agents and employees, from all claims, demands, actions, or liabilities of whatever kind and nature. including but not limited to bodily injury. death or property damage arising from, or in any way connected to, such child's use, operation, or participation in BCNY activities. I understand that BCNY will not administer any medication to members.

    I hereby give my permission for photographs and videos of him to be used in BCNY promotional materials and website. and in outside exhibitions, BCNY events. newspaper articles, TV features, online videos, or publications approved by BCNY. I additionally permit his artwork to be used by BCNY for sale or presentation to BCNY board members, supporters. or guestsof any kind without compensation. If he attends boarding school, I give my permission for his registration to remain active until graduation. I also give permission for him to participate in BCNY surveys. I understand that BCNY reserves the right to placehim on an alternate or abridged schedule if it is deemed appropriate. Additionally, I do hereby give consent to BCNY's Program staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible. 

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  • HEALTH RECORD FOR CHILDREN IN DAY CAMPS AFTERSCHOOL & YOUTH CENTERS

    This side to be filled in by parent
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  • CONSENT FOR EMERGENCY MEDICAL TREATMENT

    I do hereby give consent to The Boys' Club of New York staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible.

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  • FOR MEMBERS AGES 12 & UP

  • Dear Parent/Guardian:

    To ensure the safety of your child, The Boys’ Club of New York (BCNY) will not permit members in the Junior Department aged 10-12 to travel home on their own unless written consent is provided.

    If the member is comfortable traveling home without staff assistance, the member’s parent or legal guardian must sign and submit the written consent form below to the clubhouse registrar. If you have questions or concerns, please contact the Clubhouse Director.

    (Gerry: terrence.taylor@bcny.org Abbe: ron.britt@bcny.org)

  • I,* give my son, * permission to travel home without an adult escort upon dismissal from the Clubhouse.

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  • VACCINATION REQUIREMENT

  • Dear BCNY community,

    This school year, BCNY staff is fully vaccinated to serve your children and do our utmost to keep our communities safe. As you know, the Delta variant has been spreading across New York City. As part of our mission, we want to make sure we continue to serve our community of boys and young men with a vaccination requirement for eligible BCNY members.

    BCNY requires all members eligible for a Covid 19 vaccine, currently 12 years old and up, be vaccinated with at least their first dose by October 12th, 2021 and fully vaccinated by November 16th, 2021.

    Please upload the member’s Covid 19 vaccination proof (a photograph of member Covid 19 vaccination card) October 12th and, if applicable, proof of second dose by November 16th. Don’t hesitate to call your local clubhouse with questions or if you cannot upload member vaccination proof, please hand it in directly to the clubhouse registrar.

    We are aware there are named conditions which would preclude a child from being vaccinated. If this is the case, we need you to submit documentation by your child's physician exempting them from the Covid 19 vaccine in lieu of vaccination proof by October 12th, 2021 using the link https://bit.ly/3hETNs9 

    Legal guardians and members 18 and over, please sign and date this form to acknowledge you have read and understood BCNY’s vaccination requirement.

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