Pontiac Youth Recreation & Enrichment Center

825 Golf Dr,
Pontiac, MI 48341

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Pontiac Club Registration Form
Session Options *
Afternoon (General/Recreational Programming) CHECK ALL THAT APPLY
Parent Information
(Priority spots for youth of first responders and essential workers)
Emergency Contact Information (other than listed parent)
My child is in good health: *
My child’s immunizations are up to date: *
The immunization record or the appropriate waiver is on file with my child’s school: *
Waiver

I acknowledge on behalf of myself, any other parent or guardian of youth participating in this program that I will indemnify and hold harmless Pontiac Youth Recreation and Enrichment Center (PYREC), their agents, officers, employees, partners and volunteers from any and all liability, claim, suits, demands, damages, costs, judgements, interests and expenses (including attorney fees, legal fees, medical fees, etc.) arising directly or indirectly from the youth’s participation in PYREC programs and activities. I waive all claims against PYREC to the fullest extent of the law and will not hold PYREC, its agents, officers, employees, partners and volunteers liable if any participating youth, their fellow household members or extended family becomes infected or diagnosed with COVID-19 as a result of their participation in PYREC programming. I also waive the right of myself, any participating youth and anyone picking that youth up from the PYREC to refuse a temperature check upon entering the building. Those with temperatures at or above 99.5 will not be allowed into the PYREC for seven days with the last three being symptom free (clock resets anytime symptoms persist or arise). The health information about my child that I have provided to the Y (including my child’s immunization records) is complete and correct so far as I know. My child has permission to engage in all prescribed activities except as not in his/her registration materials
I consent for photographs and videography in which participants may appear, which can be used in anyway by PYREC to support the mission of PYREC. Ways include but are not limited to: our annual impact report. Social media posts, grant applications, special event programs, communication with donors and more. You can opt out by initialing here: __________
In the event myself or any emergency contact cannot be reached in the event of an emergency, I hereby authorize PYREC to allow any physician, medical facility or healthcare provider, including paramedics, to provide any emergency medical treatment deemed necessary by those professional in the event of injury or illness of the participating youth.
I agree with the above waiver information: *
I consent for photographs and videography in which participants may appear, which can be used in anyway by PYREC to support the mission of PYREC. Ways include but are not limited to: our annual impact report. Social media posts, grant applications, special event programs, communication with donors and more. You can opt out by initialing below:
I consent for photographs and videography waiver: *
Remind Phone App Authorization
You give PYREC sites permission to text me using the Remind App regarding club closing and hour changes, activities, announcements, etc. This will allow me stay in constant contact with my club. (Renewal will be every year to stay up to date!). If you do not sign or add a phone number you receive this free service
You give PYREC permission to text me using the Remind App regarding PYREC closing and hour changes, activities, announcements, etc. This will allow me stay in constant contact with my PYREC. (Renewal will be every year to stay up to date!). If you do not sign or add a phone number you receive this free service
PYREC - Code of Conduct
I will always be respectful and responsible to staff members, club members and overall, the PYREC itself.
Bullying will not be tolerated! If I do have a problem with another member, staff member or outside person, I will let the staff know and not take it into my own hands.
I will always also keep my cell phone and electronic devices put away and use it in the office when I ask a staff member, only to contact my parents when needed. My phone/electronic device will be taken away until my parents come to pick me up if they are out and I am subject to disciplinary actions if I continue to bring it out.
Being a member of the Club, I am to set an example for my fellow members. If my attitude and behavior does not reflect that of a leader, my parents will be contacted, and I am subject to disciplinary actions. Attitudes and disrespect will not be tolerated!
I understand, if I exhibit any of these behaviors, I will be subject to disciplinary actions.