Adult or Guardian Name
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First Name
Last Name
Phone
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Date of Birth
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MM
DD
YYYY
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
We're curious: Do you live in the West Central neighborhood?
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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
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Date of Birth for Adult 2
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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.
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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.
MEMBERSHIP TERMS
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Your Spark Central membership allows access to borrowing materials, using technology, and participating in services and programs. Memberships are non-transferable. Misuse of resources, failure to follow staff directions or posted rules, or any behavior that is unsafe, disruptive, or disrespectful may result in the suspension or termination of membership privileges. In such cases, members will be notified by staff, and reinstatement will be considered on a case-by-case basis. Signing up for membership opts you in to receiving emails from Spark Central, which members may choose to opt out of once enrolled.
YOUTH ATTENDANCE GUIDELINES
Spark Central is a public, multi-age creative space—not a licensed childcare facility. These guidelines ensure clarity for families, staff, and volunteers.
1. Youth Age 10 and Older
• Youth age 10 and up may visit Spark Central independently only if a parent or legal guardian has signed this agreement.
• Youth must check in with their parent/guardian upon arrival before being left at Spark Central.
• Spark Central does not supervise youth in general areas unless they are enrolled in a structured, supervised program.
2. Youth Under Age 10
• Children under 10 must be accompanied at all times by a parent, legal guardian, or a designated caregiver who is at least 13 years old. If a child is left with a designated caregiver who is between the ages of 13 and 18, that caregiver must have a membership.
• Spark Central staff and volunteers will not assume responsibility for children under age 10 who are left unsupervised.
3. Behavior and Safety
• Youth are expected to follow Spark Central’s Code of Conduct and show respect to staff, volunteers, and fellow patrons.
• If an unaccompanied youth becomes disruptive, is at risk, or needs support staff cannot provide, Spark Central will contact the listed parent or guardian.
• If the parent/guardian cannot be reached, Spark Central reserves the right to contact appropriate authorities for the youth’s safety.
IMPORTANT NOTICE TO PARENTS AND GUARDIANS: PLEASE READ CAREFULLY
Spark Central provides access to digital tools and a welcoming public environment. However, Spark Central is not a supervised childcare facility. We do not monitor youth continuously and do not provide real-time oversight of internet activity.
By allowing your child to visit or use technology independently at Spark Central, you acknowledge and agree that:
• Spark Central staff and volunteers do not supervise general space or online activity in real time.
• While filtering software is in place, no system is completely secure or foolproof.
• Your child may be exposed to inappropriate content, unsolicited contact from others, peer conflict, or accidental sharing of personal information.
• You are fully responsible for your child’s behavior, safety, and readiness to participate independently.
• Spark Central staff may intervene when possible but are not responsible for monitoring individual youth behavior or safety in open, public areas.
Please use this information to make an informed decision about your child’s independent participation.
TECHNOLOGY USE AGREEMENT: GUIDELINES, SAFETY, AND LIABILITY WAIVER (ALL MEMBERS)
Spark Central provides internet-connected devices for creativity, learning, and community engagement. The following rules apply to all users — youth and adults:
Permitted Use
• Completing school assignments
• Engaging in Spark Central programs
• Pursuing personal creative projects aligned with Spark’s mission
Prohibited Use
• Accessing or sharing explicit, violent, discriminatory, or inappropriate content
• Attempting to bypass internet filters or change settings
• Downloading unauthorized software
• Harassing or contacting others inappropriately
• Viewing/listening to media without headphones
• Using social platforms or messaging tools without educational need or staff approval
Expectations for All Members
• Protect your own and others’ personal information
• Use headphones and respect others in the space
• Log out and return devices after use
• Report unsafe or inappropriate content to staff
Consequences for Misuse
Spark Central may restrict or revoke technology access for misuse and reserves the right to suspend or terminate membership in serious cases.
PRINTING & DEVICE USE
Each member receives 10 black-and-white / color prints per day free. Additional black-and-white or color pages are available at posted rates. Flash drives may be borrowed; installing personal software is not allowed.
MEDIA RELEASE
Spark Central may occasionally take photos of adult or youth members, or work they share at Spark Central, and publish these photos in our printed materials, 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.
[ ] Opt Out: Note that if you opt-out of our media release, please inform our staff to avoid you or your children if they are taking pictures or video in the space.
AGREEMENT TO TERMS OF MEMBERSHIP
I have read and understood the policies and terms outlined above, including the guidelines for youth attendance, technology use, and member responsibilities. I agree to follow all Spark Central rules and expectations. I understand that failure to do so may result in the suspension or revocation of membership and/or access to services.
I affirm that the personal information I have provided is true and accurate to the best of my knowledge, and I will notify Spark Central if any of my contact information changes.
