IMPORTANT NOTE ABOUT SUBMITTING YOUR
STUDENT MEMBERSHIP APPLICATION
By electronically submitting this form, you are in good faith acknowledging that BOTH the student and a parent or guardian will review the following Student Membership Application, check the appropriate boxes as indicated, and submit data that is truthful and accurate.
If a Student Membership Application is submitted using inaccurate information, it may result in permanent loss of privileges or denial of membership. If it is revealed that a Student Membership Application has been submitted without parent/guardian consent, it may result in permanent loss of privileges or denial of membership.
The Bridge Teen Center may contact a parent or guardian to verify that the information submitted electronically in this Student Membership Application is truthful and accurate. By clicking the "Proceed to Application" link below, you are agreeing to these terms.
Proceed to Application
Eligibility Requirements & Code of Conduct:
Both Student and Parent/Legal Guardian needs to read and sign below.
Click here to read the Eligibility Requirements and Code of Conduct
The Bridge Teen Center is a private entity that serves students without regard to race, color, sex,
age, residency, national or ethnic origin, religion, sexual orientation, ancestry, or any other
protected status. To qualify for programs and events at The Bridge Teen Center, students must meet
the criteria listed below. Otherwise qualified persons are not subject to discrimination.
- Be in 7th-12th grade (begin summer entering 7th grade through summer after HS graduation) AND be at least 12, but less than 19 years of age.
- Adhere to the code of conduct and respect staff and volunteers at all times.
- Be able to function independently during programs and events AND communicate effectively with adults and other students.
- Not require The Bridge to make fundamental alterations to and/or disrupt the harmony of programs and events.
- Not undermine the safety of staff, volunteers, students, or themselves.
The Bridge reserves the right to deny service at any time based on any of the aforementioned eligibility requirements,
or for any other reason, including the actions of the student, parent, or guardian.
These eligibility requirements are subject to change without notice, and are permanently posted on our website for review at
any time. At The Bridge Teen Center we maintain a safe and fun atmosphere for students based on the following Code of Conduct:
B e faithful to attend the program you signed up for or contact The Bridge within 48 hours of the event if you need to cancel.
R emain in the building for the length of the program unless you have communicated with both the Bridge staff and your parent(s).
I nteract and respect others-Bridge staff, volunteers and other students; listen when others talk.
D ecide to be responsible for your attitude by being open and teachable.
G o with the flow, honor The Bridge's and other people's space and property. This is an illegal substance and weapon free facility.
E ncourage rather than put down others. Language, slurs, or imagery that may be offensive to any age, gender, race, sexual orientation, disability, or religion is not tolerated.
If students are unable to adhere to the Code of Conduct and have repeated or extreme infractions,
The Bridge reserves the right to contact student's guardian/parent(s) and/or the authorities.
The Bridge reserves the right to suspend membership privileges, require community service to regain
membership privileges, or terminate membership at the discretion of the Bridge staff.
By checking this box I, the Student, signify that I have read and agree to the Code of Conduct.
By checking this box I, the Parent/Legal Guardian, signify that I have read and agree to the Code of Conduct.
This information will NOT be shared outside of The Bridge Teen Center.
Emergency Contact (Other than Parent):
In case of emergency during a Bridge Event, list who The Bridge can contact.
Health Conditions and Special Needs:
It is the responsibility of student and parent to disclose all relevant information.
Additional information or physician's clearance may be required.
NO Health Conditions/Needs
ADHD / ADD
Diet or Activity Restrictions
Does the applicant have any diagnosed or undiagnosed special needs in the following areas?
Authorization of Medical Treatment:
Parent/Legal Guardian needs to read and check the box below.
Permission to Transport:
Parent/Legal Guardian needs to read and check the box below.
By checking this box I signify that I give permission for my child to be transported as necessary to off-site Bridge Teen Center events.
Both Student and Parent/Legal Guardian needs to read and check the boxes below.
Click here to read the Release Agreement
In consideration of participation at The Bridge Teen Center (BTC), we, the undersigned parent/legal
representative/guardian and student ("Releasor Student") (the parent/legal representative/guardian
and Releasor Student shall be individually and collectively referred to herein as "Releasors"), hereby
agree to indemnify and hold harmless and covenant not to sue BTC or its employees, agents, successors,
assigns, volunteers, officers, and directors (individually and collectively referred to herein as
"Releasees") and hereby waive, release and discharge Releasees from any and all claims for loss or damage,
death, personal or bodily injury, or property damage which Releasors may have or which hereinafter may
accrue to Releasors against Releasees and for any liability arising out of or connected in any way with
Releasors' participation with BTC. Releasors hereby agree to indemnify and hold harmless and release from
all liability, claims, demands, causes of action, charges, expenses, and attorney fees resulting from or
relating to involvement in any activity at BTC or involvement with The BTC, whether caused by any negligent
act or omission of the Releasees or otherwise. It is further understood and agreed that this waiver and
release has been entered into freely and will be binding upon Releasors and their heirs, successors, and
assigns. Releasors expressly agree that the foregoing release and waiver, indemnity agreement and assumption
of risk are intended to be as broad and inclusive as permitted by Illinois law and that, if any portion of
this agreement is held invalid, void, or unenforceable for any reason, it is agreed that the balance or
remainder shall, notwithstanding, continue to be in full legal force and effect. By signing this document,
Releasors agree to allow images of Releasor Student (video, photo, other digital media) captured during
programs/events to be utilized in printed materials, online or through the media. Releasors agree to waive
any rights of compensation or ownership of these images. The Bridge Teen Center is not liable for images
of your child (including Releasor Student) that are "tagged" or posted by other individuals on social media
or other websites.
I, as Releasor, acknowledge I have read and agree to the program policies, permissions and Code of Conduct.
By signing below I acknowledge I have read this document (Student Membership Application, including this
Release Agreement), agree to same, and understand its contents.
By checking this box I, the Student, signify that I have read and agree to the Release Agreement.
By checking this box I, the Parent/Legal Guardian, signify that I have read and agree to the Release Agreement.