Teen Center @ The HUB Permission Form

As part of our commitment to ensuring a safe and supportive environment for our youth employees, we require each youth and their parent or guardian to complete the following form and media waiver.

Parent/Guardian Info

Code of Conduct

The Hub Teen Center is a safe, welcoming, and inclusive space where youth can learn, connect, have fun, and grow. To help create a positive environment for everyone, all members agree to:

1. Treat others with respect. Be kind, inclusive, and respectful to fellow participants, staff, volunteers, and guests.

2. Help keep the Teen Center safe. Fighting, bullying, harassment, threats, discrimination, or other unsafe behavior will not be tolerated.

3. Follow staff directions. Staff are responsible for maintaining a safe and positive environment, and their instructions must be followed.

4. Respect the space and equipment. Clean up after yourself and use facilities, technology, games, supplies, and equipment responsibly.

5. Stay substance-free. Alcohol, tobacco, vaping products, drugs, and other prohibited substances are not allowed at the Teen Center or during Teen Center activities.

6. Do not bring weapons or dangerous items. Any weapon or item that could cause harm to yourself or others is strictly prohibited.

7. Use technology appropriately. Cyberbullying, sharing inappropriate content, misuse of devices, or using technology to harm, harass, or intimidate others is not permitted.

8. Take responsibility for your actions. Members who violate Teen Center expectations may receive a warning, parent/guardian contact, loss of privileges, suspension, or removal from the program depending on the nature and severity of the behavior. Serious safety violations may result in immediate suspension.

Medical Policy & Release

In case of sudden illness or an accident requiring immediate treatment or surgery during this program or activity, I authorize the chaperone(s) to take such action as seems appropriate to protect the health and physical well-being of the above participant. This authority extends to any EMS/EMT provider, physician(s), and/or surgeon(s) selected by the event coordinator(s) to perform medical and/or surgical procedures including examinations and tests necessary to preserve the health and physical well-being of the above-named participant. All efforts will be made to contact the parent(s) or guardian(s) in case of emergency.

We do not have medical records for your child on-hand. We also do not carry medical equipment (like epi pens). If your child has a medical condition or allergy, they must come to work with any medical equipment, prescriptions, etc. that they require.

Media Release

The Winchendon CAC and partnering organizations, such as United Way , routinely promote programs and activities involving minors through various media. This includes, but is not limited to, social media, newsletters, newspapers, brochures, and displays. In doing so, the names and photos of members may be included to help tell the story.  The Media Waiver grants us permission to include your child in photographs, videos, and other media related to programs at the CAC and partnering organizations. These materials may be used for promotional purposes, including but not limited to our website, social media channels, and print publications.

By completing and submitting this form, I provide my electronic consent that my child [named above] has permission to participate in employment, and related activities through employment, with the CAC.

I hereby release and agree to hold CAC inclusive of all of the partner organizations and businesses harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act, or that may otherwise arise in any way in connection with any volunteer or programming with CAC.

I understand that this release discharges CAC from any liability or claim that I, my heirs, or any personal representatives may have against the organization with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any volunteer or programs with CAC. This liability waiver and release extends to the organization together with all owners, partners, and employees.