Event Permission Form

NDSU Basketball Game Permission Form

EVENT DETAILS: NDSU Bison vs. Northern Illinois basketball game

We have 20 tickets, first-come, first served. The CLUB Teen Center is taking teens to attend the NDSU vs. Northern Illinois basketball game! Please review the event details and complete the permission form below. Please note: Teens must ride the bus to join in the fun.

Event Information:

Game NDSU vs. Northern Illinois

Date: Saturday, November 21, 2026

Arrival at Midtown: 1:45 PM

Bus Departure: 2:00 PM

Game Start Time: 3:00 PM

Approximate return to The CLUB Teen Center at 6:00 PM–6:45 PM.

Important: Please make sure your teen arrives at Midtown by 1:45 pm so we can get organized and depart on time. Parents/guardians should plan to pick up their teen at Midtown between 6:00 pm and 6:45 pm.

REGISTER

Name of CLUB teen attending:

Address/City/State:

Date of birth:

Parent/guardian name:

Address/City/State:

Parent/guardian phone number:

Parent/guardian email address:

Emergency contact phone number:

Emergency contact name if parent/guardian cannot be reached:

I give permission for my teen to travel by bus/vehicle arranged by the CLUB Teen Center to and from the NDSU vs. Northern Illinois game on Saturday, November 21, 2026. INITIAL HERE:

Name of person who will be picking up teen from The CLUB Teen Center after the event. (Photo ID required):

Phone number:

I give The Club Teen Center staff permission to dispense hand sanitizer to my teen:

Yes

Does your teen have allergies:

Yes

If yes, please list allergies, medical concerns/conditions:

I give The Club Teen Center photo/video permission for promotional purposes for my teen:

Yes

I hereby authorize the Boys & Girls Clubs to secure/release emergency medical attention for my child under the following conditions: An emergency or unanticipated condition necessitates immediate action for the preservation of the life or health of my child and reasonable attempts to contact me have failed:

Yes

In consideration of the acceptance of the participation of myself and any of the minors whose names appear on this form, I hereby on my behalf and their behalf, release the Boys & Girls Clubs of the Red River Valley its agents and employees from all claims for injuries or property damage that I or they may sustain arising out of the activities associated with the program. I and any such minor recognize and acknowledge that there are risks of physical injury to the participants in the activities both know and unknown and I agree for myself and on their behalf to assume the risks of such injuries, damages, or loss which I or they may sustains as a result of participation in the activities associated with the Boys & Girls Clubs programs. INITIAL HERE:

I release the Boys & Girls Clubs of the Red River Valley and its agents and employees from any such claims and I agree to indemnify and hold the Boys & Girls Clubs of the Red River Valley, its agents and employees harmless from any claims by any of the minors listed on this form arising out of or in any way related to the programs. I further agree to defend, hold harmless, and indemnify the Boys & Girls Clubs of the Red River Valley and its managers or officers from any claims, cause of action, damage, demand, expense, fine, liability, or penalty arising out of my child’s participation in the program activities. I agree with the above statements and give permission for my teen to attend the event. INITIAL HERE:

Parent/guardian signature:

By providing an electronic signature, I hereby certify that the information provided is true and correct to the best of my knowledge and belief.

I agree

If you have any questions please contact Paige at paigel@bgcrrv.org

REGISTER

Administrative Office

Midtown Youth Center

2500 18th St. South

Fargo, ND 58103

Phone: (701) 235-2147

Fax: (701) 235-9970

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