2022-23 BCNY Membership Application  Logo
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  • 2022-23 MEMBERSHIP REGISTRATION

  • OPENING DAY

    BCNY’s Fall 2022 afterschool program starts on MONDAY, SEPTEMBER 12. 

    Please note, there will be no Saturday Academy. Explorers (grades 2-5)* can enroll for afterschool programming, Monday - Friday.

    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*

    Abbe Clubhouse: Boys and young men currently enrolled in 2ND GRADE and up to 20 years old for the 2022-2023 School Year.

    Gerry Clubhouse: Boys and young men currently enrolled in 2ND GRADE and up to 20 years old for the 2022-2023 School Year.

    REQUIRED REGISTRATION DOCUMENTS

    • Birth Certificate/Passport (a photocopy is acceptable)
    • Immunization Records 
    • Allergy Action Plan
    • CACFP Food Form
    • Consent to treat (signed, dated in 2022 or later) ovide 2021-22 School Year Report Card

    ATTENDANCE POLICY

    Registered members are expected to attend and abide by the attendance policy determined by the member’s specific program. 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

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

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  • 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

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  • 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, his artwork or other assets created through BCNY to be used in BCNY promotional content and materials, emails, social media, website and any platform of our choosing now and in the future, and in outside exhibitions, BCNY events, newspaper articles, TV features, online videos, or publications/social media accounts approved by BCNY. I additionally permit his artwork to be used by BCNY for sale or presentation to BCNY board members, supporters, or guests of any kind without compensation. I give permission for him to participate in BCNY surveys and interviews for promotional content. I also opt-into BCNY emails, newsletters and communications. If he attends boarding school, I give my permission for his registration to remain active until graduation. I understand that BCNY reserves the right to place him 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

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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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