RENEW YOUR FREE MEMBERSHIP

Please complete the form below TO RENEW:

Adult/Guardian Name *
Adult/Guardian Name
Phone *
Phone
Date of Birth *
Date of Birth
Address *
Address
Statistical Info (optional)
This data helps us apply for grant funding and is kept confidential.
Adult/Guardian 2 (optional)
Adult/Guardian 2 (optional)
If you have a second adult at this same address, you add them at the same time.
Phone for Adult 2
Phone for Adult 2
Date of Birth for Adult 2
Date of Birth for Adult 2
Statistical Info (optional) for Adult 2
This data helps us apply for grant funding and is kept confidential.
ADD YOUTH IN HOME
You may renew up to 4 youth members, or add them if they are not already members. We receive funding based on how many youth we serve, so adding the youth in your home greatly helps us!
Youth 1 Name
Youth 1 Name
Youth 1 Date of Birth
Youth 1 Date of Birth
Statistical Info (optional) for Youth 1
This data helps us apply for grant funding and is kept confidential.
Youth 2 Name
Youth 2 Name
Youth 2 Date of Birth
Youth 2 Date of Birth
Statistical Info (optional) for Youth 2
This data helps us apply for grant funding and is kept confidential.
Youth 3 Name
Youth 3 Name
Youth 3 Date of Birth
Youth 3 Date of Birth
Statistical Info (optional) for Youth 3
This data helps us apply for grant funding and is kept confidential.
Youth 4 Name
Youth 4 Name
Youth 4 Date of Birth
Youth 4 Date of Birth
Statistical Info (optional) for Youth 4
This data helps us apply for grant funding and is kept confidential.
TERMS OF MEMBERSHIP AGREEMENT
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. Fines and fees from overdue or damaged materials totaling $5.00 or more per responsible party (responsibility for minors residing with adult or guardian) may cause the inactivation of borrowing privileges. Privileges will resume when fines and fees have been paid. 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 10 to be in the center without parent supervision. We ask that children 10 years or younger be accompanied by a parent or caregiver over the age of 14. 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. 
[ ] 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: 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.