The Rock Teen Centers - Membership Form

**This Form MUST be filled out by a Parent, Guardian, or Member over the age of 18**

IF MEMBER IS UNDER 18, START FORM WITH PARENT/GUARDIAN INFORMATION (see "Add Child" Below)

Emergency Contact Information is REQUIRED Membership at The Rock Teen Centers is free for teens 12 through 20.

Your name *

Email address *

How Did You Hear About Our Centers? *

Phone number *

Birthdate *

Please Enter An Emergency Contact (First Name - Relationship to Teen): *

Emergency Contact Phone Number: *

Enter Teen(s) Information (Under 18) With +Add Child

Enter child's LEGAL NAME for safety reasons
Enter other Emergency Contacts using +Add Adult

Household members

Address *

Primary campus *

School Name *

(Type "Out of School" or "Home-schooled" if applies)

I have read and agree to this Liability Waiver. Must be 18 or older to complete. *

I understand that I am giving Alice Cooper Solid Rock Teen Centers consent to use photos or videos of me/my teen for promotional and/or advertising purposes. I also have read the completed application and understand the Code of Conduct (SEE BELOW) for Alice Cooper Solid Rock Teen Centers and request myself/my teen be admitted into membership.

Recognizing the risks of illness and injury inherent in any program, I am enrolling the me/the above teen into membership and understand that I am hereby waiving and releasing Alice Cooper Solid Rock Teen Centers, the owners/directors, their families and instructors from any and all claims, costs, liabilities, expenses, or judgments, including any attorney’s fees and court costs arising out of participation in programs on or off the premises or any illness or injury resulting therein.

I hereby grant Alice Cooper Solid Rock Teen Centers permission to administer first aid help and/or call 911 in case of medical emergency while me/my teen is attending classes, rehearsals and performances. I understand that Alice Cooper Solid Rock Teen Centers will attempt to first notify parents and/or guardians in case of emergency. I understand that in case of illness, injury, accident, or any other damage to myself/my teen or property while participating in Alice Coopers Solid Rock Teen Centers sponsored activities on or off premises, which may require attention by medical professionals, I will bear the expense personally or by insurance that I have provided for family or myself.

I agree to all the policies and procedures of Alice Cooper Solid Rock Teen Centers as stated above.

Myself and my teen(s) have read and agree to this Commitment to Our Culture. *

We ask that you join the commitment to our culture as you become a member of The Rock Teen Centers.

Simply:

Be Respectful
Respect is our priority. We are all created equal, regardless of race, religion, gender, or social class. We commit to treating one another as we would each like to be treated.

Please treat your peers and the Solid Rock staff and volunteers with respect. We are all here to create an enjoyable environment together. This means to please use appropriate language, care for the furniture and equipment, and reset anything you use back to how you found it.

Be Honest
We commit to mutual honesty. If you need help or advice with a situation, please speak with a staff member or volunteer. We are here to help.

Be Helpful
We receive help and give help. Be sensitive to the feelings of others. Offer a helping hand if you see someone who needs a friend. Set a good example for those around you and if you need help make sure to reach out.

I understand that I may lose the privilege to enjoy time at The Rock Teen Center either temporarily or permanently by not upholding The Rock Teen Center’s culture. I intend to behave in a manner that supports and promotes this safe environment. I also agree to not use Solid Rock's name in any variation to create content of any kind without written permission.

*This commitment is not intended to be a comprehensive list. Those not upholding our cultural commitment will be addressed on a case-by-case basis.

Please check your email upon submission.

Once form is submitted you will receive a welcome email to confirm your registration.

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