2025 BGC of the Lowcountry- H. E. McCracken Middle School Club Membership Application

2025 Boys & Girls Club of the Lowcountry- H.E. McCracken Middle School Club Membership Application
Afterschool Days: Monday-Friday 4:00-6:00 pm

H. E. McCracken Middle School

250 H. E. McCracken

Bluffton, SC 29910

(843) 706-8700

Confidentiality: All confidential information requested is for our records and for the funding our Organization receives. The answers you provide will be kept completely confidential. Your cooperation in providing this information is both appreciated and necessary.

Our Mission
To enable all young people, especially those who need us most, to reach their full potential as productive, caring, responsible citizens.

Our Vision
To be the benchmark agency for nurturing hope and development of the whole child.
Member Information
Club Member #1:
Member Name/Nombre del miembro*

First Name/El Nombre PrimeroLast Name/Appelido
Date of Birth/Fecha de nacimiento*

MonthDayYear
Age/Edad*
Gender/Género*

FemaleMale
Member Ethnicity /Etnicidad del miembro*
Grade /Grado *
Medical History (check all that apply)/ Historial médico (marque todo lo que corresponda)*

NONEFrequent Ear InfectionsAllergiesDiseaseHeart Defect/DiseaseHay FeverChicken PoxConvulsions/SeizuresPoison IvyMeaslesDiabetesPenicillinMumpsBleeding DisorderAsthmaOther
Please list any allergies for your child and/or medications he/she receives./ Por favor, indique cualquier alergia de su hijo y/o los medicamentos que recibe.
Club Member #2:
Member Name/Nombre del miembro

First Name/El Nombre PrimeroLast Name/Appelido
Date of Birth/Fecha de nacimiento

MonthDayYear
Age/Edad
Gender/Género

FemaleMale
Member Ethnicity /Etnicidad del miembro
Grade /Grado
Medical History (check all that apply)/ Historial médico (marque todo lo que corresponda)

NONEFrequent Ear InfectionsAllergiesDiseaseHeart Defect/DiseaseHay FeverChicken PoxConvulsions/SeizuresPoison IvyMeaslesDiabetesPenicillinMumpsBleeding DisorderAsthmaOther
Please list any allergies for your child and/or medications he/she receives./ Por favor, indique cualquier alergia de su hijo y/o los medicamentos que recibe.
Club Member #3:
Member Name/Nombre del miembro

First Name/El Nombre PrimeroLast Name/Appelido
Date of Birth/Fecha de nacimiento

MonthDayYear
Age/Edad
Gender/Género

FemaleMale
Member Ethnicity /Etnicidad del miembro
Grade /Grado
Medical History (check all that apply)/ Historial médico (marque todo lo que corresponda)

NONEFrequent Ear InfectionsAllergiesDiseaseHeart Defect/DiseaseHay FeverChicken PoxConvulsions/SeizuresPoison IvyMeaslesDiabetesPenicillinMumpsBleeding DisorderAsthmaOther
Please list any allergies for your child and/or medications he/she receives./ Por favor, indique cualquier alergia de su hijo y/o los medicamentos que recibe.
Membership Information/Información de membresía
Membership/Afiliación

Guest/Invitada-InvitadoStaff Parent/Padre del personalSummer Only/Solo VeranoAfter School Only/Sólo después de la escuela
Pick Up Authorization Password/Recoger contraseña de autorización
Head of Household/Jefe de familia
Head of Household (Primary Contact)/Jefe de Hogar (Contacto Principal)*

First Name/El Nombre PrimeroLast Name/Appelido
Relationship to Member*
Address/DIRECCIÓN*

Street address/Dirección postal

Street addres 2 /Dirección postal 2

City/CiudadState / Province/Estado

Postal / Zip Code/Código postal
Cell Phone #/Teléfono móvil #*

Area Code/Código de áreaPhone Number/Número de teléfono
Work Phone Number/Número de teléfono del trabajo

Area Code/Código de áreaPhone Number/Número de teléfono
Email/Correo electrónico*
example@example.com/ejemplo@ejemplo.com
Head of the Household Employer/Jefe de Hogar Empleador
Name of Employer/Nombre de la empleadora - Nombre del empleador
Job Title / Occupation:/Título profesional/ocupación:
Job Title / Occupation/Título profesional/ocupación
Military/Branch:/Militar/Rama:
Other Parent or Guardian:/Otra madre o tutor:/Otro padre o tutor:

First Name/El Nombre PrimeroLast Name/Appelido
Relationship to Member/ Relación con el miembro
Address/DIRECCIÓN

Street address/Dirección postal

Street addres 2 /Dirección postal 2

City/CiudadState / Province/Estado

Postal / Zip Code/Código postal
Cell Phone #/Teléfono móvil #

Area Code/Código de áreaPhone Number/Número de teléfono
Work Phone Number/Número de teléfono del trabajo

Area Code/Código de áreaPhone Number/Número de teléfono
Email/Correo electrónico
example@example.com/ejemplo@ejemplo.com
Empleadora/Empleador
Name of Employer/Nombre de la empleadora - Nombre del empleador
Job Title / Occupation:/Título profesional/ocupación:
Job Title / Occupation/Título profesional/ocupación
Military/Branch:/Militar/Rama:
Family Income/Ingreso familiar*

9000 or less9001 - 1200012001-1500015001-1900019001-2300023001-2800028001-3270032701-3750037500-4200042001+
Family Size/Tamaño de la familia*
Household Type/Tipo de hogar*

Adoptive Parent/Madre adoptivaFoster Care/Cuidado de crianzaSingle Mother/madre solteraSingle Father/padre solteroGroup Home/Hogar del grupoFamily/Familia
Family Setting/Ambiente familiar*

Both ParentsCo-Parent(s)Father & Step-ParentMother & Step-ParentGrandparentMother OnlyFather OnlyFoster Parent(s)
Check All That Apply/Marque todo lo que corresponda*

TANFFood StampsGeneral AssistanceSSDISSIFree/Reduced School LunchMedicaidCan Swim
Medical Information
Medical Insurance/ Seguro médico

Insurance Company

Insurance Policy #

Name of Insured

Medications
Family Pediatrician
Family Pediatrician/Physician/ Pediatra familiar
Physician Name
Pediatrician Phone Number/ Número de teléfono del pediatra
Please enter a valid phone number.
Hospital (nearest to home address)
Hospital Name
Hospital Phone Number
Please enter a valid phone number.
Pick Up Information:

Two people (other than parents) should be authorized to pick up your child/children.
Name/ Nombre

First NameLast Name
Relationship to Member/ Relación con el miembro
Relationship
Phone Number/ número de teléfono
Please enter a valid phone number.
Name/ Nombre

First NameLast Name
Relationship to Member/ Relación con el miembro
Relationship
Phone Number/ número de teléfono
Please enter a valid phone number.
Name/ Nombre

First NameLast Name
Relationship to Member/ Relación con el miembro
Relationship
Phone Number/ número de teléfono
Please enter a valid phone number.
Please read the following statements and policies of the Boys & Girls Club of the Lowcountry. By checking the "I agree" box, you agree to follow our procedures, policies and rules.
The Boys & Girls Club of the Lowcountry Behavior and Disclipinary Consequences for lesser Offenses:

Ages 11+

1. Take away special privileges for the day (Field trip, contest, party, etc.)

2. Have the child write answers to reflective questions which are put in the child's permanent file.

3. Assign the child to a supervised "clean up/pick up" detail. Length of time dependent on the supervisor.

Staff will select one of the three options listed above when a discipline incident occurs. Children in time out or who are willing answers to questions are to be placed in a quite area of the room they are in. All discipline "events" are to be documented by filling out either an Individual Member's Behavior and Discipline Report and/or a Conference Required form are to be completed by the staff person who initiates the discipline consequence.
I understand the above and agree to these options as presented for my child/children.

Yes, I agree
The Boys & Girls Clubs of the Lowcountry Guidance and Discipline Policies/Agreement

The staff of the Boys & Girls Club of the Lowcountry has developed the following guidelines and consequences for behavior within the facility, during programs and on the club property. Inappropriate behaviors and consequences are divided into three major categories and listed below.

LESSER OFFENSES:

- Not abiding by the posted Boys & Girls Club Behavior Expectations

- Refusal to cooperate, talking back, etc.

- Horseplay and/or play-fighting (slapping, pushing, spitting, fighting, chocking, karate, etc.)

-Being disruptive during programming or not participating in programming.

-Inappropriate language(profanity, racial name calling, yelling, gender jokes or use of the middle finger)

-Running in the hall or program areas

-Eating outside of designated areas/times

-Abusing equipment of facilities (slamming doors)

-Leaving designated areas without permission

-Playing in bathrooms

-Bringing electronic devices in the club (cell phones, pagers, electronic games)

A staff member will record these lesser offenses. After 3 offenses, a parent/guardian conference is required, after which a suspension may follow.

IMMEDIATE SUSPENSION- behaviors include:

- Inappropriate sexual behavior

- Disrespecting staff

- Smoking

- Stealing

- Gambling

- Fighting or other physical aggresion (kicking, hitting, slapping, biting, pushing)

These behaviors will result in an immediate short-term suspension, usually ranging in length from 2-4 days, depending on the seriousness of the offense and the number of prior offenses. You will immediately be notified and your child will be pulled from programming to await pick-up. Your child must be picked up within one hour after we contact you. After the first hour, a fine of $10 per hour will be charged until your child is picked up. The fine must be piad and a conference held before your child can return to the Club. The Boys & Girls Club reserves the right to call the polices of DSS if you child is not picked up or if your child is dropped off without the required parent's conference.

INDEFINITE SUSPENSION - behaviors include:

- Possession of a weapon (law enforcement will be contacted)

- Verbal or written threats to bodily harm

- Hitting a staff member

- Vandalism of equipment or property

- Disruption and/or use of drugs or alcohol (law enforcement will be contacted)

These behaviors will result in an immediate suspension and possible indefinite suspension at the discretion of the Director and/or the Executive Director. As in an immediate suspension, your child will be pulled from programming and you will be called to pick up your child at once. If a child is suspended from one club, they are then suspended from all Clubs.

Written documentation of every occurrence will be submited to the Unit Director for his/her signature and placed in the member's permanent file.
I understand the above and agree to these options as presented for my child/children.

Yes, I agree
I agree to the following:

EMERGENCY HEALTH TREATMENT:

I hereby give permission to the physician selected by the Boys & Girls Club staff to order x-ray, routine tests and treatment for health of my child. In the event I cannot be reached in an EMERGENCY, I hereby give my permission to the physician selected by the Boys & Girls Club staff to be hospitalized, secure proper treatment for, and to order injections and/or surgery for my child.

PHOTO PERMISSION:

I hereby give my permission to have photographs taken of my child as a Boys & Girls Club member. I am aware that any pictures taken may be used in marketing materials, such as brochures, newspaper, flyers, magazine articles and any other printed material for the benefit of the Boys & Girls Club. This includes social media.

REPORT CARD PERMISSION:

I hereby give permission to allow education staff at the Boys & Girls Club to obtain a copy of my child's report card for the purpose of evaluating his/her additional educational needs.

Returned Checks & Fee Reimbursement:

I am aware that a charge of $25.00 will be applied to checks that are returned for insufficient funds and that there is no reimbursement for fees paid.
I understand the above and agree to these options as presented for my child/children.

Yes, I agree
2025 After-School Program Expectations (Members & Parents)

Members:

- Members are required to check in at arrival.

Daily Middle School rotation:

4:00-4:20 pm: Check-in, Dinner

4:20-5:05 pm: Power hour & Tutoring

5:05-5:40 pm: Enrichment Activities

5:40-6:00 pm: Clean up & Snack Time

6:00 pm: Dismissal

- Members are to clean up after themselves in all areas of the Club - we are a family and it takes all of us to keep our home clean.

- Members do not open any doors for people outside of the club unless advised by an adult staff

- Respect staff, your peers & yourself (manners)

- Power Hour is a quiet opportunity to complete your homework; if you don't have homework, read quietly or do quiet educational activities provided by staff.

Parents:

- Club closes at 6:00 pm - after 6:05 pm late fees will start accruing

- Monthly Fee is due the 1st of each month

- Please read all documents that are emailed out for things such as important dates & monthly calendars to stay informed

- Refer to our guidance & discipline policy

- Ensure telephone numbers and pickup list are up to date*

- ID is required for unauthorized pickup

- All medications are to be checked in at with Site Director.

- Add us on Facebook & Instagram - Search Boys & Girls Club of Bluffton
I understand the above and agree to these options as presented for my child/children.

Yes, I agree
Behavior Expectations

- Club is for members only. No guests are allowed.

- Treat our people and our property with dignity and respect.

- Enter & Exit the building through designated doors only.

- Members sign in everyday.

- Members are expected to participate in activities and programs, which are scheduled by age appropriate groups.

- Members must walk at all times unless participating in a running activity in the gym.

- Horseplay, fighting and profanity are not allowed.

- Hats, bandanas, scarves and skullies are not allowed to be worn in the building.

- Dress Code must be followed at all times.

- Eating and drinking are allowed in designated areas and times only.

- Gum chewing and the use of tobacco products is not allowed.

- The Club is not responsible for lost or stolen items.
I understand the above and agree to these options as presented for my child/children.

Yes, I agree
Dress Code

Members attending Boys & Girls Club of the Lowcountry H. E. McCracken Middle School Afterschool program will follow Beaufort School District Dress Code.
I understand the above and agree to these options as presented for my child/children.

Yes, I agree
I, being the parent or legal guardian of the child listed above, have read the completed application, have read the rules of the BGC of the Locountry H. E. McCracken and request that my son/daughter be admitted to membership. I have explained the rules to my son/daughter and agree that the BGC of the Lowcountry H. E. McCracken will not be responsible for any accident to the boy/girl while on the BGC of the Lowcountry H. E. McCracken premises or while engaged in any of its activities away from the BGC of the Lowcountry H. E. McCracken.

I give my consent for photographs, in which my son/daughter may appear, to be used in any way the BGC of the Lowcounrty H. E. McCracken may care to use them. I agree to assume these risks and hereby release from liability and agree to hold harmless the Boys and Girls Clubs of the Lowcountry, its Board of Directors and members, employees, staff, volunteers, and other representatives associated with this activity. I also give my explicit permission to sponsoring adult(s) to administer first aid and to seek and obtain further emergency medical treatment for my child as deemed necessary.

I give permission for the Beaufort County School District to share data and information with B&G Club of the Lowcountry for the purpose of obtaining: MAP ELA & MATH scores.
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
Head of Household Signature/ Firma del jefe de hogar

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2025 Boys & Girls Club of the Lowcountry- H.E. McCracken Middle School Club Membership Application

Afterschool Days: Monday-Friday 4:00-6:00 pm

H. E. McCracken Middle School

250 H. E. McCracken

Bluffton, SC 29910

(843) 706-8700