YOUTH MEMBERSHIP FORM

Aspen Youth Center requires all youth members to fill out a membership form, one for each youth in the family. Our programs are free of charge. Any data that AYC collects is depersonalized—no identifying information, like names, birthdates, or unique information is used. The data is used only in grant and donation requests and reports.

Please know that you are not required to share medical information with AYC staff, however, it helps us to best serve your child. Allergies, disabilities, medical issues, and behavioral issues are kept confidential unless your written permission is granted for us to share details with certified youth support contractors.

You can also obtain a membership form at our facility located inside of the Aspen Recreation Center.

Please contact Michaela Idhammar-Ketpura with any questions at michaela@aspenyouthcenter.org 

Youth Membership Form

  • Head of Household

  • Other Parents/Guardian Information

  • Other Emergency Contact

  • Household Information

  • YOUTH INFORMATION

  • Academic Information

  • Medical Issues or Allergies

  • Parent/Guardian Consent

  • By signing below, I hereby give permission for my child/dependent to become a member of Aspen Youth Center (AYC). I understand that my child/dependent may enter and leave AYC at will. AYC is not responsible for personal injury or loss of personal property. I give permission for my child to participate in any activities offered at AYC and understand the nature and potential risks of such activities including injury and/or bodily harm.

    I understand that in the case of an emergency involving my child/dependent, every effort will be made to contact me and/or the individual designated on this form as “Emergency Contact”. In the event that neither I, nor the designated “Emergency Contact” can be reached, I hereby give the AYC Staff my permission to contact emergency medical services and enlist available medical professionals in the evaluation and treatment (including surgery) of my child/dependent.

    In addition, I authorize AYC to use and reproduce any and all photographs and/or video footage of my child/dependent which may be taken in connection with AYC activities for any purpose without compensation. I understand that all such photographs and/or video footage of my child/dependent is the sole property of AYC.

    I understand that my child/dependent may be asked to participate in evaluations and/or surveys and that any information my child/dependent provides will only be used internally by AYC.

    I understand that, as a member of AYC, my child/dependent will have access to the internet and while precautions are in place, it is possible that my child/dependent may access inappropriate web sites. AYC does have rules regarding such behavior but I understand that AYC cannot be responsible for any consequence of such access.

  • This field is for validation purposes and should be left unchanged.