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Summer V Camp (Virtual Program)

Register for Summer V Camp

Participant Information
If your child is a current Club member, please select their Club location:
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Please enter information if applicable:
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Please enter information if applicable:
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Please enter information if appliable
Parent/Guardian Information
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In Case of Emergency Information
Please provide the following information in case an emergency arises and we can not get in contact with you at any of the phone numbers listed above. Experience shows it is best for you to list 2 individuals, other than parents, that do not live with you.
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Memorandum of Agreement

I/we, the parent(s)/guardian(s) of the child/children listed above understand that the Boys & Girls Clubs of the Pee Dee Area, Inc. makes available organized educational and recreational activities for its’ members.  I/we understand that there are always dangers and risks connected in participation in such activities (particularly athletics) and, as Parents/Guardians of the child named above, I/we hereby give my/our approval of his/her participation in all activities of the club.  I/we understand that responsibility for any and all such risks and dangers and I/we do hereby release, indemnify and hold harmless the Boys & Girls Clubs of the Pee Dee Area, Inc. and Boys & Girls Clubs of America, the organizers, sponsors, supervisors and staff of all its’ activities, from any and all liability in connection with any injury (including any injury caused by their own negligence) to the child named above.

Publicity Release

I hereby consent to the reproduction, publication and use of photographs or video taken of my child, items (artwork, photos, videos, etc.) submitted to the Boys & Girls Clubs of the Pee Dee Area can be used for advertising, educational and/or publicity purposes in any and all publications, advertisements and publicity materials, without limitation or reservation.  I also consent to any use of testimony or copy written by or about my child that may accompany said photographs or stand alone in any and all publications, advertisements and publicity materials, without limitation or reservation.

Zoom Consent

In an effort to continuously serve members during the Club closure, Boys & Girls Clubs of the Pee Dee Area is providing distance-based Club experiences through which Club staff will facilitate program activities through an online platform. Boys & Girls Clubs of the Pee Dee Area will use an application provided by a third party that members, parents/guardians and/or staff will access via the Internet and use for purposes of communication and programming. This platform is called Zoom.

This letter seeks consent for your child to utilize Zoom for distance-based Club program purposes. Zoom provides an opportunity to deliver video and chat-based educational experiences to members via any device. Please be aware that Zoom collects information about its users and has its own privacy terms and conditions to which members must adhere. Please review Zoom’s privacy terms and conditions carefully before registering your member:  http://zoom.us/terms and http://zoom.us/privacy.

In order to participate in distance-based Club experiences, you will need to provide the following:

  •  A computer, mobile, or tablet device with access to the Internet
  • A quiet space at home in which members can participate in distance-based experiences under the supervision of an adult
  • To register for Zoom, you will need to provide some customer data, including but not limited to:  your email address and first and last name (for more information, see https://zoom.us/privacy)  

We will use Zoom for the following anticipated program activities:

  •  Group chats
  • Video conferencing
  • Media sharing (for example, uploading images of artwork or other projects) 

Our commitment to keeping the young people we serve safe is always our number one priority. Boys & Girls Clubs of the Pee Dee Area will actively monitor member activity on Zoom and will make every effort to protect member information by, among other things, maintaining control of, and access to, the data collected; prohibiting re-disclosure of member information; limiting the purposes for which the online platforms may use member information; ensuring there is no advertising and that no member information is collected for commercial purposes.

By entering your name, you agree to the terms and conditions set forth, and your name will serve in place of a signature
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