Registration for MYC Extended Day

Starts April 5th. Register for a week at a time. We are following all COVID guidelines of the town Board of Health, state, and CDC.

This program is open to students ages 8-18, with structured programming available for grades 3-8 and Open Gym for grades 6-12. Participants must either attend Milford Public Schools or be a Milford Resident. It includes a snack and dinner option every day.

Once registered, a MYC staff will be in contact to confirm enrollment. If a waitlist is created due to limited space, Milford Youth Center will contact families in the order of enrollment date, as space becomes available.

Unfortunately, at this time we do not have a method of providing transportation from Woodland Elementary to the Youth Center. We have been working on possibilities, but for now we recommend carpooling.

Individual Use Waiver

Please fill out the following information:

Parent/Guardian First Name *

Parent/Guardian Last Name *

Email Address *

Phone Number *

Street Address *

Address Line 2

City *

State *

Zip Code *

Mobile Phone Number *

Child's Name: *

Birthday: * +

2nd Child's Name:

2nd Birthday: +

3rd Child's Name:

3rd Birthday: +

4th Child's Name:

4th Birthday: +

5th Child's Name:

5th Birthday: +

Please read each statement noting that you have read and agree to the terms of use:

Please be reminded that NO FOOD OR DRINK is allowed into the gymnasium, game room, computer lab without the permission of the Director.
You are responsible for any damage to Milford Youth Center equipment caused by improper handling or carelessness.
In the event of any damage to building (ex, gymnasium floor, graffiti, etc.), from whatever cause, the individual and/or group organizer will be fully responsible for the cost of any and all repairs or replacement.
The program organizer(s), group chaperones, the Milford Youth Commission, the town of Milford and their respective employees and agents shall not be liable for any personal injury (including death), damages, or loss to my person or property arising from my participation in this program. It is further agreed that in consideration of being so permitted to participate, (I)(we) do forever release, acquit, discharge and covenant to hold harmless the Milford Youth Commission and the Town of Milford, and their successors, departments, officers, employees, servants, and agents, of and from any and all actions, causes of action, claims, demands, damages, costs, loss of services, expenses and compensation on account of, or in any way growing out of, directly or indirectly all known and unknown personal injury or property damage which may hereafter occur, and also any claims or rights of actions for damages which have or hereafter may acquire, resulting from participation in the subject excursion.

To the greatest extent permitted by law, the above Parent/Guardian whose signature is below, agrees to defend, indemnify and hold harmless the Owner, the Town of Milford, and its agents, servants, employees, successors, heirs, executors, insurers, attorneys, administrators and all other representatives, of and from any and all claims, liabilities and actions for damages or other relief, whether sounding in contract, tort, or otherwise, on account of or in any way arising out of and/or relating to the aforementioned child(ren)'s use of the property, including but not limited to incidents involving the Owner’s negligence. The duty to defend shall immediately accrue and be owing upon the utterance of such a claim by any person or entity regardless of merit and shall not be dependent upon a finding of negligence or any other finding of fact at trial. The duty to defend shall be absolute and will include and shall not be defeated or in any way undermined by the utterance of claims not covered by this agreement.

Date: * +

The signing of this form shall constitute an agreement to all regulations governing use of Town of Milford facilities and to accept full responsibility for damage to or loss of municipal property and for payment of all fees assessed for such use. *

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Photo Release

I understand that my child(ren)’s name and photo may be used in photographs, videos, literature, web pages, and news releases in local papers and other media outlets. I, the aforementioned Parent/Guarndian, give permission for my son/daughter(s) to be photographed and named for MYC rental for the Milord Youth Center. *

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MYC Extended Day

Dates Requested *

	Yes	No
Week of Tuesday June 1 - Friday June 4	Yes	No
Week of Monday June 7- Thursday June 10	Yes	No

Is your child interested in our Organized Programming (3rd - 8th grades) or just Open Gym (6th to 12th grades)? *

Organized Programming (3rd-8th grade)

Open Gym (6th to 12th grade)

This does not guarantee your child a spot. A Milford Youth Center staff member will be in touch to confirm registration. Due to limited availability to allow for social distancing, we will be in touch individually to confirm and arrange payment.

Emergency Contacts and Authorized Pickups

In the event that you are unable to pick up your child at the end of the day or unable to be contacted in the event of an emergency, we need names and phone numbers of authorized pickups and emergency contacts. Please fill out their information here. We will be asking for an ID at pickup

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact 2 Name

Emergency Contact 2 Phone Number

I give permission for my child to walk home without being picked up by an authorized adult *

Yes

No

Authorized Pickup Name *

Authorized Pickup Phone Number *

Authorized Pickup 2 Name

Authorized Pickup 2 Phone Number

Authorized Pickup 3 Name

Authorized Pickup 3 Phone Number

Authorized Pickup 4 Name

Authorized Pickup 4 Phone Number

Medical Information

I give my permission for the Milford Youth Center to provide first aid if needed and to transport to the hospital of choice if emergency care is needed. *

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Does your child have any allergies? *

Yes

No

Does your second child have any allergies? *

Yes

No

Does your third child have any allergies? *

Yes

No

Does your fourth child have any allergies? *

Yes

No

Does your fifth child have any allergies? *

Yes

No

What are your child(ren)'s allergies? If more than one child, please specify who has the allergies *

Does your child(ren) need medication during this program? *

Yes

No

What medication does your child need during this program? *

Do we have your permission to give your child(ren) hand sanitizer during this program? *

Yes

No

Are there other medical concerns and if so, what are they?

I understand that I need to fill out a daily health attestation form as a COVID precaution and give my permission for the Milford Youth Center to take my child's temperature on a daily basis. I further understand that if my child's temperature is above 100.0, they will need to be picked up and not able to return for 48 hours, upon the condition that they are fever free without the use of medication. *

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