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P.A.R.C. Membership Application

  1. Pennsylvania Avenue Resource Center Membership Application
  2. Membership Type:*
  3. Basic Information (Primary Applicant)
  4. What is your ethnicity?*
    Please select all that apply.
  5. Basic Information (Secondary Applicant)
  6. What is your ethnicity?
    Please select all that apply.
  7. #1 Youth Information
  8. Any past incidents resulting in:
    Please check all that apply
  9. *Please note, structured PARC youth after school programming is limited to middle school and high school students.
  10. #2 Youth Information
  11. Any past incidents resulting in:
    Please check all that apply
  12. #3 Youth Information
  13. Any past incidents resulting in:
    Please check all that apply
  14. #4 Youth Information
  15. Any past incidents resulting in:
    Please check all that apply
  16. Emergency Medical Information
  17. Statement of Medical Consent
    In the event of an emergency or non-emergency situation requiring medical treatment, I give permission and consent for medical attention to be administered to myself and/or family members listed as part of my PARC membership application, including but not limited to the administration of first aid, the use of an ambulance; the administration of anesthesia, and/or surgery under the care of qualified medical personnel. I also assume the responsibility for the payment of any such treatment.
  18. Statement of Medical Consent*
  19. Assumption of Risk, Waiver of Liability, and Indemnification
    I, as the above applicant and/or the legal guardian of minor child(ren) for whom I seek PARC membership, do hereby knowingly and voluntarily agree, on behalf of myself and my children, their heirs, successors and assigns, to assume responsibility for all risks of loss, damage, or injury, (including but not limited to disability and/or death). I release, hold harmless, indemnify and forever give up any claim and demands of whatever nature, either in law or equity, against the City of Savannah, its Executive Officers, Board of Directors, employees, agents, sponsors, representatives and volunteers, of liability for any and all bodily injury (including but not limited to disability and/or death), property damage, and/or any other loss whatsoever which may arise out of, resulting from, or being associated with my own or my child(ren’s) use of, presence at, or participation in the PARC center, its property and equipment, and any of its programs on or off-site. I hereby certify that I fully understand and acknowledge said risks and responsibilities to myself and my children and hereby grant permission for my child(ren) to use the PARC and participate in center programs and activities. Internet
  20. Assumption of Risk, Waiver of Liability, and Indemnification*
  21. Internet & Equipment Use Policy
    The PARC is pleased to offer members’ access to its computers, professional culinary and other technologically advanced equipment for the purpose of furthering the educational and career goals of its members. The PARC will not be responsible for: any information that is lost or property that is damaged or unavailable due to difficulties encountered by using center computers, equipment or the internet; any damages or costs arising directly or indirectly from member activities; for the accuracy or appropriateness of information found on the Internet; or any unauthorized, inappropriate or illegal use of equipment or information by you or your child. The PARC does not control the content of information available on the internet, and parents should be advised that youth members will have access to information worldwide and therefore may come into contact with material that is inaccurate, offensive or otherwise objectionable. Members are not permitted to use the Internet, Center computers, equipment, supplies or other training tools to do harm to themselves or others or to record or access sexually explicit, pornographic, vulgar or otherwise distasteful and/or negative materials from the Internet. Personal attacks on others or language which is defamatory, obscene, abusive, profane (swearing), threatening or discriminatory will not be tolerated. There is no expressed or implied right to privacy regarding the use of the Center’s computers, recording/training equipment or the Internet by members or others. Damages to PARC property resulting from the use/handling of Center property shall be the responsibility of the member and/or parent/guardian in the case of youth members. The PARC reserves the right to monitor any and all use of its computers, equipment and internet access. Members determined to be in violation of this policy may lose access privileges, Center membership, and/or face legal action. Any information gathered can be copied, reviewed, and stored and shall remain the property of the PARC.
  22. Internet & Equipment Use Policy*
  23. Photo/Media Release
    I hereby grant permission to the PARC and/or agents acting on its behalf, the right to use, edit, reproduce, assign and distribute photographs, films, video/audio recordings and other audio/visual productions of myself and/or my child(ren) for use in public displays, publications, public relations, slide shows, newspapers, advertising and other communications, to include transmission via film, print, video, computer, worldwide web, internet website, email, FTP, computer network and digital reproduction and distribution. I indemnify and hold harmless the City of Savannah PARC, its officers, employees, sponsors and volunteers (the “indemnified parties”) from and against any and all claims of any kind, including royalties or other compensation, and any liabilities arising from or related to the use of the photographs or recordings.
  24. Photo/Media Release*
  25. Parent Responsibilities & General Transport Release
    The parent/guardian is responsible for providing and/or coordinating transportation for his/her child on a daily basis. Membership termination may result from recurring failure to ensure adequate transportation of your child. There will be occasions upon which PARC Youth Members will be transported by the PARC to and from events, field trips, and other educational and cultural activities. Permission slips must be signed by parents/guardians in order for Youth Members to attend these activities. Any youth of driving age who transports him/herself in a personal vehicle to/from a sanctioned activity is not considered to be in the care of the PARC.
  26. Parent Responsibilities & General Transport Release*
  27. I have agreed to submit this application by electronic means. My typed name in the box above will act as an electronic signature. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. By signing this application I agree that my answers are correct and complete to the best of my knowledge.
  28. Leave This Blank:

  29. This field is not part of the form submission.