Sign up now for our 2023 outreach events! Register for Monthly Youth Outreach (last Saturdays)Family MentoringYouth First Name Youth Last Name Youth Birthdate Current School Grade femalemaleYouth Age Number Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian Phone Parent/Guardian Email Emergency Contact Name Emergency Contact Phone Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryAny additional info you want us to know I accept the terms of service below I acknowledge that participation in the activity described above involves risk to the Participant (and to Participant’s parents or guardians, if Participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage and financial damage. In consideration for the opportunity to participate in the activity described above (the “Activity”), the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the Activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the Activity or during transportation to and from the activity, as well as for any medical treatment rendered to the Participant that is authorized by the Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the “Activity Sponsor”). Further, the Participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the Activity Sponsor for any injury arising directly or indirectly out of the described Activity or transportation to and from the Activity, whether such injury arises out of the negligence of the Activity Sponsor, the Participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Activity Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution pursuant to the rules of the American Arbitration Association.Parent/Guardian Signature Typing in name confirm you have agreed and signed.I accept the terms of service below NELA Youth Center aims to provide academic, vocational, social-emotional guidance, to be a safe and welcoming community, and to advocate on behalf of our youth and their families. While at The at NELA YC, students should maintain a positive attitude, strive to work on their academics, seek support for vocational and educational opportunities, build healthy relationships, and seek support and resources from NELA YC and other organizations in the community. In an effort to maintain a healthy environment and to further the mission of NELA YC, any student that consistently demonstrates an attitude that is in opposition to the mission and values of NELA YC may be asked to leave NELA YC. NELA YC expects that all students, volunteers, and staff adhere to our code of conduct and expectations while participating in NELA YC programming. If a student violates the code of conduct or expectations of NELA YC, they will first 1) be given a formal warning, followed by 2) a one day suspension from NELA YC, then 3) a week suspension, and if there are continued violations 4) a student might be permanently removed from the program. Parents will always be alerted if disciplinary action is taken on a student. - Students are expected to attend all Garage daily, planned programming, including homework hour and daily activity. Students that refuse to participate will not be permitted to ride the bus home and will need to have a parent come and pick them up. If a student lives within walking distance of The Garage, and refuses to participate, they will be asked to go home and their parents will be contacted. - There is no consumption or possession of: tobacco/vaping products or paraphernalia, alcohol, and/or drugs during programming hours as well as inside or outside of Garage facilities (building, vehicles, etc.). The Garage has the discretion to search any students that are suspected of possessing, or consuming, tobacco/vaping products, alcohol, or drugs. - The Garage has a zero tolerance for bullying. Instances of bullying should be reported to Garage staff as soon as they are observed, and will be addressed immediately. - There is no explicit language permitted during Garage programming. Students may not leave the building or other Garage areas (including field trips) without parent permission or without being accompanied by a Garage staff or volunteer. This includes students wanting to go home with another student. - There is no inappropriate touching, fighting, or other forms of physical contact towards any student, volunteer, or staff. - The Garage follows the school district’s dress code, so any clothing deemed inappropriate at school is also not permitted at The Garage. If someone arrives at The Garage with clothing deemed inappropriate, Garage staff can decide to ask that student to change or be picked up by a parent. - The Garage provides free forms of technology to benefit students in their learning. Use of Garage technology is, first and foremost, to be used constructively; recreational use of Garage technology is at the discretion of Garage staff. Garage technology is never to be used for: chat rooms, pornography, or other scenarios deemed inapproprate or unsafe by Garage staff or volunteers. - In an effort to maintain the integrity of Garage programming, Garage staff will collect phones during program time. Students will not be permitted to have their phones until they leave at the end of the day. If a parent needs to contact their child while at The Garage, Kennett parents can contact Jamie Wagner, and Avon Grove parents can contact Esmeralda Carrillo. Any student who refuses to turn in their cell phone will be asked to go home.Parent/Guardian Signature Typing in name confirm you have agreed and signed.Youth Signature Typing in name confirm you have agreed and signed.Date VerificationPlease enter any two digitsExample: 12This box is for spam protection - <strong>please leave it blank</strong>: Share this:Click to share on Facebook (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on Pinterest (Opens in new window) 2022-09-06