Adult or Guardian Name
*
First Name
Last Name
Phone
*
(###)
###
####
Date of Birth
*
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
We're curious: Do you live in the West Central neighborhood?
*
Help us learn how well we're reaching the West Central residents.
Statistical Info (optional)
This data helps us apply for grants and will be kept confidential.
Adult/Guardian 2 (optional)
If you have a second adult at this same address, you add them at the same time.
First Name
Last Name
Email for Adult 2
Phone for Adult 2
(###)
###
####
Date of Birth for Adult 2
MM
DD
YYYY
Statistical Info (optional) for Adult 2
This data helps us apply for grant funding and is kept confidential.
Youth 1 Name
First Name
Last Name
Youth 1 Date of Birth
Needed for age verification in our system.
MM
DD
YYYY
Statistical Info (optional) for Youth 1
This data helps us apply for grant funding and is kept confidential.
Youth 2 Name
First Name
Last Name
Youth 2 Date of Birth
Needed for age verification in our system.
MM
DD
YYYY
Statistical Info (optional) for Youth 2
This data helps us apply for grant funding and is kept confidential.
Youth 3 Name
First Name
Last Name
Youth 3 Date of Birth
Needed for age verification in our system.
MM
DD
YYYY
Statistical Info (optional) for Youth 3
This data helps us apply for grant funding and is kept confidential.
Youth 4 Name
First Name
Last Name
Youth 4 Date of Birth
Needed for age verification in our system.
MM
DD
YYYY
Statistical Info (optional) for Youth 4
This data helps us apply for grant funding and is kept confidential.
Terms of Membership
*
Your membership allows you to borrow Spark Central materials, use Spark Central technology, or use Spark’s available services. Memberships are not transferable to any other person. Failure to follow the rules or regulations of membership or use of Spark Central’s space may result in suspension of membership. Damage or loss of materials totaling $5.00 or more per responsible party (responsibility for minors residing with adult or guardian) may cause the inactivation of borrowing privileges. Opting into membership opts you into receiving emails from Spark Central, which members may choose to opt-out of once enrolled.
COMPUTER USE:
Spark computing devices are not to be removed from Spark Central or taken into bathrooms.
Computing devices may be borrowed for up to two hours and then must be returned.
No illegal conduct (harassment, libeling or slandering, destruction or damage, disruption or unauthorized monitoring or interference, unauthorized copying of copyrighted material, or viewing or downloading of pornography) is allowed on Spark Central computers or devices.
Spark Central staff and volunteers have the authority and duty to enforce equitable and fair access to all computing facilities at Spark.
Spark Central staff and volunteers are generally trained computer instructors. Patrons are responsible for their own use of public access computers.
Parents are responsible for monitoring and guiding use of station computers for their children.
Patrons are only authorized to access the “Spark Central” patron login and are prohibited from downloading software or other programs onto our computers. Flash drives are available.
Each day, printing your first five black-and-white pages are free, and there are charges for additional pages or color pages. See sign at help desk for rates.
UNATTENDED CHILDREN:
Spark Central holds parents / guardians, or care providers responsible for the safety and security of their children while visiting. Neither Spark Central nor the programming offered by Spark Central for children is intended to take the place of care and supervision by a parent or caregiver. Spark Central allows children over the age of 8 to be in the center without parent supervision. We ask that children 7 years or younger be accompanied by a parent or caregiver over the age of 13. If an unaccompanied child is in need of assistance that the Spark Central staff and volunteers do not or cannot provide, is disruptive to other patrons, or is at-risk, a staff member will first contact the child’s parents. If the staff member cannot reach the child’s parents they will then contact the necessary authorities.
MEDIA RELEASE:
Spark Central may occasionally take photos of adult or youth members listed on this form, or work they share at Spark Central, in our publications, social media, and/or grant applications. By signing, you consent to the reproduction and use, royalty-free, of motion picture films, videotapes, recorded sounds, and still photographs of yourself or other adults and youth listed on this form by Spark Central for purposes including, but not limited to, promotional materials, display, advertising, social media, and exhibits. By signing this form, you release Spark Central, its clients, subcontractors, owners and designees from liability for any violation of any personal or proprietary right you may have in connection with such reproduction and use. If you wish to opt out of the media release, please contact info@spark-central.org or visit Spark Central to complete your membership application.
AGREEMENT:
I have read and agree to the Terms of Membership and Computer Use Policy above. I agree to follow the guidelines in the policy. I understand that if I do not abide by the Computer Use Policy or the Terms of Membership, that my membership will be revoked. I certify that the personal information I provided is accurate to the best of my knowledge, and that I will notify Spark Central should my contact information change.
