Corning Youth Center

T.R.E.E. of Dreams Teen Space

Registration Form

To best serve the community, the Laura Richardson Houghton Corning Youth Center & T.R.E.E. of Dreams Teen Space will be open during the school year 2:45 PM - 7:00 PM for youth 8-18. Summer is July & August 8 AM - 6 PM. In order for your child(ren) to be considered, you will need to complete the attached form, and each child will need their OWN form completed. All forms must be filled out, TANF forms are a requirement by the county not by our program. We have a list of rules and regulations that must be followed for safety of youth and staff.

Are you interested in youth or teen programming for your child? *

Youth (8-13)

Teen (13-18)

Select the time of year you are registering for? *

School Year

Summer

Both (School & Summer)

Child's First Name: *

Child's Last Name: *

Child's Preferred Name/Nickname: *

Child's Age (only youth ages 8-18 can register for Youth Center programs) *

Child's Date of Birth: *

Child's Gender: *

Child's Grade: *

Parent/Guardian Name: *

Relationship to Child: *

Phone #: *

Email:

Parent/Guardian's Work Phone:

Preferred Method of Contact: *

Phone

Home Address: *

City *

State *

Zip *

Child's Activities and Interests *

Name of Child's School: *

Child's Emergency Contact Person: *

Emergency Contact Phone Number: *

Relationship to Child: *

Child's Medical Provider's Name *

Child's Medical Provider's Phone Number *

Health Insurance Information *

Is your child allergic to anything? *

Yes

Does your child have health / behavioral health concerns that we should be aware of? Such as Allergies (Shellfish, Peanut, Bee Sting, Seasonal, etc) or Behavioral Health Issues (ADHD, previous Mental Health Concerns, Substance Use Concerns, Violence, Aggression, Bullying, etc). If so or if they have any other condition, please describe below:

Parent/Guardian signature (By signing below I attest that my child will not be sent to the Youth Center if sick without a mask. I also understand that I will be asked to keep my youth home when anyone in the home has tested positive for COVID-19, I understand that my child will be isolated if becoming ill after arrival. I understand that I may be ask to provide medical documentation to allow my child back into the program if sick). *

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Date *

IMPORTANT RULES FOR CORNING YOUTH CENTER & TREE OF DREAMS

RULES THAT I WILL GO OVER WITH MY YOUTH:
1. No Vulgarities (swearing) at each other or Staff.
2. No Disrespecting Staff or other youth in the program.
3. No Bullying
4. Youth must respect the Property at the center including but not limited to the video/board games, equipment, tv's, controllers, lego's, pool sticks, ping pong balls, outside equipment, tables, chairs, etc
5. If your youth breaks things on purpose or after being asked numerous times to not do something we will request that the parent reimburse the item.
6. If your youth has behavioral problems that are unable to be controlled in the center, it will be expected that you will come pick them up.
7. If you are a parent that refuses to respect staff or assist staff with your youth when behavior issues take place, we have and will suspend as necessary.
8. We have the right to decline any registration.
9. Meal time is meal time. Which means youth will be required to sit at the tables electronic free. NOT OUTSIDE FOOD OR DRINKS ALLOWED.
10. Cell phones and laptops are becoming problematic at the center. Please be mindful and have conversations with your youth that we develop programs for them to engage in something other heads down in phones or on computers. *

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Date *