2026 Boys & Girls Club of Bluffton Membership Application

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 site your child will attend for 2026 Summer Camp

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

Member Ethnicity /Etnicidad del miembro

Member School/Escuela miembro

Grade /Grado

Member Blood Type/Grupo sanguineo del miembro

Blood Type

Medical History (check all that apply) / Historial médico (marque todas las que correspondan)

Please share important medical history or information regarding your child. (List any allergies, conditions, illnesses, etc.) / Por favor comparta información importante sobre el historial médico de su hijo/a. (Incluya cualquier alergia, condición, enfermedad, etc.)

Please list your child's current medications. / Por favor enumere los medicamentos actuales de su hijo/a.

Please confirm your child's immunizations are up to date. (Immunization records required before the first day of camp.) / Por favor confirme que las vacunas de su hijo/a están al día. (Se requieren los registros de vacunación antes del primer día del campamento.)

Please describe your child's swimming ability. / Por favor describa la habilidad de natación de su hijo/a.

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

Member Ethnicity /Etnicidad del miembro

Member School/Escuela miembro

Grade /Grado

Member Blood Type/Grupo sanguineo del miembro

Blood Type

Medical History (check all that apply) / Historial médico (marque todas las que correspondan)

Please share important medical history or information regarding your child. (List any allergies, conditions, illnesses, etc.) / Por favor comparta información importante sobre el historial médico de su hijo/a. (Incluya cualquier alergia, condición, enfermedad, etc.)

Please list your child's current medications. / Por favor enumere los medicamentos actuales de su hijo/a.

Please confirm your child's immunizations are up to date. (Immunization records required before the first day of camp.) / Por favor confirme que las vacunas de su hijo/a están al día. (Se requieren los registros de vacunación antes del primer día del campamento.)

Please describe your child's swimming ability. / Por favor describa la habilidad de natación de su hijo/a.

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

Member Ethnicity /Etnicidad del miembro

Member School/Escuela miembro

Grade /Grado

Member Blood Type/Grupo sanguineo del miembro

Blood Type

Medical History (check all that apply) / Historial médico (marque todas las que correspondan)

Please share important medical history or information regarding your child. (List any allergies, conditions, illnesses, etc.) / Por favor comparta información importante sobre el historial médico de su hijo/a. (Incluya cualquier alergia, condición, enfermedad, etc.)

Please list your child's current medications. / Por favor enumere los medicamentos actuales de su hijo/a.

Please confirm your child's immunizations are up to date. (Immunization records required before the first day of camp.) / Por favor confirme que las vacunas de su hijo/a están al día. (Se requieren los registros de vacunación antes del primer día del campamento.)

Please describe your child's swimming ability. / Por favor describa la habilidad de natación de su hijo/a.

Membership Information/Información de membresía

Membership/Afiliación

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

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

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

Family Size/Tamaño de la familia

Household Type/Tipo de hogar

Family Setting/Ambiente familiar

Check All That Apply / Marque todo lo que corresponda

Medical Information

Medical Insurance

Insurance Company

Insurance Policy #

Name of Insured

Medications

Family Pediatrician

Family Pediatrician/Physician

Physician Name

Pediatrician Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Family Dentist

Name

Dentist Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Hospital (nearest to home address)

Hospital Name

Hospital Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Pick Up Information:

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

Name

First NameLast Name

Relationship to Member

Relationship

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Name

First NameLast Name

Relationship to Member

Relationship

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Name

First NameLast Name

Relationship to Member

Relationship

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Please read the following statements and policies of the Boys & Girls Clubs of the Lowcountry. By checking the "I agree" box, you agree to follow our procedures, policies and rules.

Boys & Girls Clubs of the Lowcountry Behavior and Disclipinary Consequences for lesser Offenses:

Ages 6-9

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

2. Have the child in 15-20 minute "time out" during which the child shadows staff and does not participate in regular programming.

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

Ages 10-12

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.

Ages 13+

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.

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.

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.

TRANSPORTATION PERMISSION:

I give my permission for my child to be transported in agency-insured vehicles for field trips or special circumstances within twenty miles of the club. There will be additional permission slips beyond twenty miles of the club.

I understand the above and agree to these options as presented for my child/children.

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.

- Cell phones and other electronic equipment are 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.

Dress Code

1. Member's dress and grooming will be neat and clean.

2. Tennis shoes must be worn. Flip-flops, slippers, sandals or any similar footwear is not permitted.

3. No bare midriff shirts or blouses will be permitted.

4. No spaghetti strap tops, halter-tops, shirts with shoulder straps less than 1 inch or vests without shirts will be permitted.

5. No plain white sleeveless undershirts.

6. No see-through or mesh garments may be worn.

7. Hats, sunglasses, hair curlers or other head wear, including scarves, headbands and skullies may not be worn.

8. No clothing or jewelry will be permitted which displays profanity, suggestive phrases, alcohol, tobacco, drug advertisements or other inappropriate phrases or symbols.

9. Shorts may be worn, however, they must be properly fitted and in good taste and may not be shorter than mid thigh. Biker or spandex shorts of any kind are not permitted.

10. Skirts should fit and be in good taste and not be shorter than mid-thigh.

11. The wearing of clothes that expose inappropriate body parts or underclothing is not permitted. Trousers/slacks/shorts will be worn at waist level. Because of safety reason, Jnco trousers are not permitted.

12. Hair styles and colors and other fashions or styles which are disruptive to club activities are not permitted. Hair braiding is not allowed in the Club.

13. All clothing must be hemmed and may not drag on the floor.

14. Extraneous articles hanging from clothing, such as chains or other articles are considered inappropriate, and will not be permitted.

15. Clothing and accessories identified as gang-related are not allowed.

16. Excessive body piercing is a safety issue. Judgments on body piercing will be individually determined to protect member health and safety.

I understand the above and agree to these options as presented for my child/children.

I, being the parent or legal guardian of the child listed above, have read the completed application, have read the rules of the Boys & Girls Clubs of the Lowcountry (BGCL) and request that my son/daughter be admitted to membership. I have explained the rules to my son/daughter and agree that BGCL will not be responsible for any accident to the boy/girl while on BGCL premises or while engaged in any of its activities away from BGCL.

I give my consent for photographs, in which my son/daughter may appear, to be used by BGCL in any promotional, marketing, or other materials. 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/or Jasper County School District to share data and information with BGCA for the purpose of obtaining: MAP ELA & MATH scores.

I understand the above and agree to these options as presented for my child/children.

Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!

Head of Household Signature

Date

Please confirm your child's immunizations are up to date. (Immunization records required before the first day of camp.)

2026 Boys & Girls Clubs of the Lowcountry

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.