FORMS

| Summer Registration |

Student Registration for Summer 2025

440-296-9077

The Conneaut Youth Center is a Bible based, non-denominational organization that will provide a safe place for Middle & High School Students to learn life skills, receive tutoring, build relationships, and have fun!

WHEN: Mondays and Tuesday 10am until 2pm (starting June 9 th , 2025)

WHERE: 229 Main Street Conneaut, Ohio 44030

WHAT: CYC looks different every week. Discussions, Prayer and Worship,

games, activities and so much more!

After First Visit, Registration Form & Waiver must be read, signed, and returned to attend CYC

Childs Name

Address

Phone

Date of Birth

Month

Day

Year

Grade

Male

Female

Allergies or Food Restrictions?

LIABILITY RELEASE, INDEMNIFICATION AGREEMENT AND PHOTO RELEASE READ CAREFULLY.

PARENT/GUARDIAN SIGNATURE REQUIRED.

I hereby acknowledge there are risks associated with my child’s participation in activities at Conneaut Youth Center including, but not limited to: falls, physical recreation, and athletic activities, contact with other participants, etc. By signing below, I agree that I am assuming the

responsibility and liability for all risks. I also agree that by signing I am releasing Conneaut Youth Center and all associated organizers, their representatives and successors, participants, volunteers, and others from all claims that I may have for injuries or damages resulting in any way from my child’s participation at Conneaut Youth Center. I hereby covenant not to sue for any damages or injuries. In the event that there is any claim made because of my child’s participation that involves Conneaut Youth Center or any other individual or entity associated in any way with the Conneaut Youth Center, I agree to fully indemnify and hold them harmless from all claims for damages and also all attorney fees, expenses and costs.

I understand that at this event or related activities, my child may be photographed. I agree to allow my child’s photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, and organizers. I understand that the staff at Conneaut Youth Center holds the right to release any student from the program at any time for any reason deemed necessary. If I have signed this LIABILITY RELEASE, INDEMNIFICATION AGREEMENT AND PHOTO RELEASE on behalf of a minor, it is my intent to bind both myself and that person to the terms of this agreement

Please check to indicate you have medical insurance/Medicaid coverage for your child.

Please check if you give your child permission to walk to and walk home CYC.

Please check if you will pick up your child from CYC.

Please check to indicate you have received and reviewed with your child “CYC Information and Guidelines for Summer 2025”

Name of Student or Students

Name of Parent or Guardian

Parent or Guardian Phone

Emergency Contact Name (if parent/guardian can’t be reached):

Emergency Contact Phone number

Signature

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Information and Guidelines for Summer 2025

✓Conneaut Youth Center programming at 229 Main Street Conneaut.

✓The Conneaut Youth Center is a Bible based, non-denominational organization that will provide a safe place for students to learn life skills, receive tutoring, build relationships, and have fun!

✓Conneaut Youth Center will be open Monday and Tuesday 10am until 2pm

✓This program is for all Middle School and High School students including homeschoolers.

✓All students must have a completed 2025 Registration Form on file after their first initial visit otherwise they cannot continue to attend.

✓The Conneaut Youth Center believes that everyone is a human that God created.

✓Conneaut Youth Center will provide a safe Biblical Environment for students.

✓There will also be space to socialize and play games.

✓Special activities will include physical fitness, crafts, life skills coaching, community service

opportunities, special speakers, live worship and so much more!

✓If a student leaves the building, they must sign out and they will not be allowed to re-enter.

✓If a student does not attend school on a day the Conneaut Youth Center is in session, then the student cannot attend the after-school program on that day.

✓Behavioral problems will not be tolerated. This includes bullying, any form of harassment, blatant disrespect of others, and not adhering to Conneaut Youth Center rules which are listed below.

✓The staff at Conneaut Youth Center holds the right to release any student from the program at any time for any reason deem necessary

*Be Respectful *Be Positive *Be Kind

*Clean up after yourself

*Keep hands and feet to yourself

*No Drugs, Alcohol, Smoking or Vaping

*Help out where help is needed

*No foul language or cursing

*No PDA (public display of affection)

*Cell phone use should be kept at a minimum