Nantucket Boys & Girls Club
Child's Information
Nombre del Miembro
Apellido del Miembro
Origen étnico
Fecha de nacimiento
CONSENTS | My child has permission to:

El miembro tiene permiso para ser utilizado en materialies de marketing

Ir en bicicleta a casa

Caminar hacia casa
Member Medical Information
Permiso para tratamiento por parte del médico/hospital

Notas o excepciones

¿Tiene su hijo alguna afección crónica de salud?

¿Tu hijo tiene alergias?
¿Su hijo lleva alguno de los siguientes?
If your child requires an inhaler, epi-pen, or medication, he/she must have access to them while at the Club. We suggest dropping of an extra for the Club medication box. 

¿Alguna información adicional que el NBGC deba conocer?
Parents/Legal Guardian Information
Nombre del tutor legal
Dirección de correo electrónico
Número de teléfono
Nombre del tutor legal
Dirección de correo electrónico
Número de Teléfono
Emergency Contact Information/Infarmación en caso de Emergencia
Número de Teléfono
Parent/Guardian Waiver + Acknowledgments

Parent/Guardian Acknowledgment and Consent

I hereby give consent for my child to participate in the Nantucket Boys & Girls Club 2022 Summer Sports Camp Program and further give my authorization to the Staff of the Nantucket Boys & Girls Club to arrange for routine or emergency medical care and treatment necessary to preserve the health of my child. I acknowledge that I am responsible for all reasonable charges in connection with care and treatment rendered and agree not to hold the Nantucket Boys & Girls or any member of their staff responsible in the unlikely event of an accident. 

Nantucket Boys & Girls Club complies with regulations of the Massachusetts Department of Public Health and is licensed by Nantucket Health Department.  Parents may request copies of background checks, health care and discipline policies, by contacting the Executive Director.

COVID Assumption of Risk & Waiver Letter

Dear Parents and Guardians, 

As you are certainly aware, COVID-19 is an extremely contagious communicable illness that is spread through person-to-person interactions. Not all individuals infected with COVID-19 display any symptoms, but such individuals may nonetheless be contagious and spread the infection. State and local authorities are closely monitoring the spread of COVID-19 in the Commonwealth of Massachusetts and on Nantucket, and have introduced mandatory quarantines, social distancing and other safety measures to prevent the spread of the disease. Please also note that the Club’s plans will also be subject to change based on evolving guidance and changes in federal, state and/or local mandates or guidance.

Although NBGC will comply with all applicable safety requirements, so long as COVID-19 continues to spread by community transmission and until there is an effective vaccine, there will be a risk that members could become infected with COVID-19 despite those efforts.

  • That risk extends to the families of members as well.

  • By electing to send your child to the Nantucket Boys & Girls Club this school year, you acknowledge and agree that the safety policies and procedures outlined above are reasonable under the circumstances, and that there is nonetheless a risk that your child could contract COVID-19 and/or become a symptomatic and/or asymptomatic carrier of COVID-19 despite the above safety policies and procedures.

  • By signing below, you knowingly and voluntarily assume that risk, as well as the risk that such infection could spread to other members of your child’s household or family.

  • By signing below, you hereby agree, on your own behalf and on that of your child, and of your heirs, executors, administrators, personal representatives, and/or assigns (“Releasors”), to forever release, acquit, discharge, and covenant to hold harmless Nantucket Boys & Girls Club, its trustees, employees, volunteers, representatives, and agents (“Releasees”) from any and all claims, suits, liabilities, and actions, including, but not limited to, any negligence of Releasees, which Releasors may have, now or in the future, which relate in any way to your child contracting COVID-19, or any symptoms or complications arising from COVID-19, as a result of attending any NBGC programs.

Finally, in these uncertain times, you understand and agree that the duties and obligations of the Club may be modified or suspended immediately and without notice because of causes beyond the Club’s control, such as threats to the health and safety of members and staff, including the Covid-19 pandemic or actions by Government officials or health officials regarding the pandemic. If such an event occurs, you acknowledge and agree that the Club is not obligated to provide any refunds of payments made to the Club.


Jamie Foster, Executive Director

Haga clic aquí para obtener una traducción al español de las exenciones de responsabilidad y exenciones.

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  • This is the NBGC Summer Sports Camp registration form for incoming 3rd-4th graders
  • Days: Monday-Friday
  • Time: 1-2pm
  • Location: Nantucket Boys & Girls Club, 61 Sparks Avenue
  • $50/Week
  • July 4th: There will be no Summer Sports Camp due to the Holiday
This is free for children enrolled in at least one week of the NBGC Summer Camp Program.
Week Selection
Please select which weeks you'd like your child to participate:

All fees are due by June 27th, 2022. The NBGC Summer Sports Camp fee is non-refundable except for extraordinary circumstances. 
Payment Information

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