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Nichols Club in Naples

239-325-1700
Administrative Office
7500 Davis Boulevard, Naples, FL 34104

Bolch Club in Immokalee

239-675-7003
1155 Roberts Avenue West Immokalee, FL 34142

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Parent Consent Form – Virtual Clubhouse

Please complete the form below:

PARENT CONSENT FORM – VIRTUAL CLUBHOUSE

Today's Date*
MM slash DD slash YYYY
Has your child ever attended a Boys & Girls Club of Collier County program?*
- Yes
- No
Parent Name*
First Last
Parent Email*
Parent Alternate Email
Parent Home Phone
Parent Cell Phone*
Permission to text
I give permission to the Boys & Girls Club of Collier County to send text alerts to my cell phone.
Parent Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Parent Employer*
Parent Employer Phone*
Parent Employer Address*
Street Address Address Line 2 City State ZIP Code
Secondary Parent / Guardian Name
First Last
Secondary Parent / Guardian Email
Secondary Parent / Guardian Alternative Email
Secondary Parent / Guardian Home Phone
Secondary Parent / Guardian Cell Phone
Permission to text
I give permission to the Boys & Girls Club of Collier County to send text alerts to my cell phone.
Secondary Parent / Guardian Address
Street Address Address Line 2 City State ZIP Code
Secondary Parent / Guardian Employer
Secondary Parent / Guardian Employer Phone
Secondary Parent / Guardian Employer Address
Street Address Address Line 2 City State ZIP Code
Child Name*
First Last
Child Gender*
- Male
- Female
Child Date of Birth*
MM slash DD slash YYYY
Child Age*
Child Current Grade*
Child Club Member Number (if Club member)
Child Race*
- Asian
- African American
- Hispanic
- Mulitracial
- Caucasian
Child Ethnicity
- Hispanic
- Haitian
Parent / Guardian Permission*
I give permission for child/children to participate in distance-based online Club experiences at Boys & Girls Club of Collier County. I understand that my child/children may be photographed and/or video recorded by the Boys & Girls Club of Collier County during virtual programming. I understand that my child/children may appear in training videos, social media, photographs, television appearances, and other outlets.
Permission to use Zoom*
I give my child/children permission 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. Zoom collects information about its users and has its own privacy terms and conditions to which members must adhere. Zoom’s privacy terms and conditions can be viewed at: http://zoom.us/terms and http://zoom.us/privacy.
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June 23rd, 2021

Middle-schoolers get a head start on career readiness at Boys and Girls Club

Read More Read Middle-schoolers get a head start on career readiness at Boys and Girls Club

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Nichols Club in Naples

Administrative Office
7500 Davis Boulevard, Naples, FL 34104

Phone: 239-325-1700

Bolch Club in Immokalee

1155 Roberts Avenue West Immokalee, FL 34142

Phone: 239-675-7003

Charity Navigator 4 stars

Programs

Virtual Clubhouse
Out-of-Club Virtual Daily Lessons
Core Programs
Sports Leagues & Clinics
21st Century Community Learning Centers
Youth of the Year
Junior Culinary Arts Program

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