Register for the Youth Centre

2024-2025

theROC Youth Centre Registration & Consent Form

All Prince Edward County Youth ages 12 – 18 are welcome to become a member at no cost.

Youth and a guardian must complete the Youth Centre Registration & Consent Form (see below) before being allowed to participate in Youth Centre events, programs, workshops and/or trainings.

Please read the General Terms and Conditions of Participation.

theROC is a registered charity providing supervised opportunities, mentorship and programs in a safe environment that encourages youth success and contributes to a healthier community in Prince Edward County. Although all activities are supervised, guardians must be aware that youth are free to come and go as they please.

theROC has a barrier-free policy. the ROC offers snacks and taxis when funding allows for it.

How to get started and become a member (youth).

Reach out to request a tour or stop by to learn more

Call or e-mail us for more information about the services and programs theROC provides. Schedule a tour to see the space and meet our staff!

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"*" indicates required fields

Email*

Legal First Name of Youth*

Legal Last Name of Youth*

Preferred Name (if different from above)

Date of Birth

Current Address*

What town/village do you currently live in?*

Emergency contact information

Name of Emergency Contact*

Relation to Youth*

Cellphone*

Alternate Phone

Youth Centre Activity Permission

As the legal guardian of the youth named above, I give this youth permission to attend and participate in the programs available at the theROC Youth Services located at 299 Main Street, Picton ON.

Yes

As the legal guardian of the youth named above, I agree not to hold any member of theROC Youth Services Board of Directors, staff, volunteers, representatives and their affiliates responsible for any case of injury, damages, or loss during theROC Youth Services' programs and drop in activities.

Yes

As the legal guardian of the youth named above, I consent for any photographs, video images/recordings, and interviews taken of this youth to be used for media purposes, including both traditional and digital or social promotionals, presentations and/or marketing campaigns. I understand that this youth may be involved in activities and programs that will be covered by the media, and that they may be photographed and named in such events. Photographs, video images, voice recordings and interviews are the property of “theROC Youth Services”.

Yes

Youth Centre Code of Conduct

theROC Youth Services' policies and procedures are built on a foundation of mutual respect. theROC Youth Services' staff promise to respect each youth’s autonomy, abilities, privacy and boundaries. We promise to always put the health, safety and best interests of youth first. In return, we ask that youth adhere to the following:

1. To have FUN by engaging safely while at the Youth Centre.
2. To be respectful of others including all staff, peers, volunteers and youth centre belongings.
3. To actively participate in Youth Centre programs, activities and events.
4. To be smart enough to stay away from the Youth Centre if you are engaging in drugs or alcohol.
5. To come to staff if you need to talk, or need help. We are here for you!

As the legal guardian of the youth named above, I have discussed the Youth Centre Code of Conduct with the them and they agree to follow the rules outlined above.

Yes

By checking here, you confirm that you, the consenting guardian, have read and understand this "theROC Youth Services Registration and Consent Form". This form will remain in effect until this youth is 18 years of age, or is cancelled in writing to the theROC Youth Services by the consenting guardian.

Yes

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