Registration Packet
At the Best Buy Teen Tech Center, youth pursue their interests and use new technologies with
help from other teens and adult mentors. Then, they can share their work with peers across
the globe through the Intel Computer Clubhouse Network. Technology and multimedia tools
are available for music and video production, interactive programming, digital photography,
graphic design and much more.
The Teen Tech Center is designed to be a safe, comfortable, fun space. Membership is limited
to youth ages 11-19. To become a member, please complete the forms in this packet and
return them to the Tech Center Manager. This packet includes a Member Code of Conduct, a
Member Information Form, and a Parent/Guardian Permission Form to be signed by a parent
or legal guardian. You’ll also need to sign in each time you use the space.
Send completed forms to:
Mickael Charles
Teen Tech Center Manager
Email: mcharles@miamisci.org
Tel: 305-646-4380
Fax: 305-646-4300
The Teen Tech Center is located at 3280 South Miami Ave., across from Vizcaya Station. Check out
miamisci.org/ttc for more information.
This project was made possible through a grant from Best Buy. Best Buy Teen Tech Centers are part of
Best Buy’s commitment to fuel the next generation of innovators. To learn more, visit
www.bestbuy.com and click on “Community Relations”.
Member Code of Conduct
The Best Buy Teen Tech Center at the Miami Science Museum strives to provide a safe, comfortable atmosphere, in which members of the Tech Center Community may explore their own creativity. To that end, you are now asked to agree to the following statements:
1. All members of the Teen Tech Center Community are encouraged to explore their own creativity. I will help this happen by not doing anything to disrupt or discourage another's creative expression.
2. I know that the Teen Tech Center is everyone's space. If I choose to play music or sound files, I will play it so that it does not disturb others. In addition, I will not play any music containing profanity. I will also adhere to the Teen Tech Center Internet Safety Guidelines so that no one in the Tech Center will be exposed to inappropriate material and/or people who wish to misuse the Internet.
3. In an attempt to make everyone feel comfortable in the Teen Tech Center, I will not use profanity and/or discriminatory language. In addition, I will not use language that purposefully offends another member of the Teen Tech Center.
4. In an effort to ensure the safety of everyone in the Teen Tech Center community, I will not steal, pirate software, or engage in any other illegal activity, including possession and/or use of narcotics or weapons. 5. I realize that the Teen Tech Center is limited in resources and we are lucky to have all the equipment that we
have. I will do my best to respect the Teen Tech Center space. I will not purposefully destroy or vandalize any property of the Teen Tech Center or of another Teen Tech Center community member. I will also help to keep the Teen Tech Center clean by picking up after myself.
6. The Teen Tech Center is filled with different kinds of people from various backgrounds. I will help create a feeling of community by respecting everyone I come in contact with and treating them how I would want to be treated. Both physical and verbal fighting will not be tolerated. If I have a problem I cannot solve peacefully myself, I will talk to a staff member and allow them to handle it.
If the code of conduct is broken, I will be subject to the following disciplinary action:
• For a minor infraction (cursing under my breath, rough-housing, not following staff instructions, etc.), I will be warned by a member of the staff. If I get warned three times in one day, I will be asked to leave and be suspended for one day. If this behavior becomes habitual, the staff will take appropriate action.
• For a major infraction (getting into a verbal altercation, vandalism, verbal abuse of another member, etc.), I will be asked to leave and be suspended for one week. If this behavior becomes habitual, the staff will take appropriate action.
• For engaging in physical violence and/or illegal activity — as mentioned in number 4 — in or near the Tech Center, I will forfeit my membership.
If you violate the Code of Conduct and are subject to suspension, a member of the staff will sit down and discuss the situation with you before any disciplinary action is taken. You will be given an opportunity to explain your actions and advocate on your own behalf.
I have read, understand, and agree to adhere to this Code of Conduct.
Member Information Form
Contact Information
Member First Name: __________________________ Member Last Name: ____________________________ School: ____________________________________ Grade: ___________ Date of Birth: _______________ Address: ___________________________________________________________________________________ City: _______________________________________ State: ____________ ZIP/Postal Code: ____________ Home: _________________________ Cell: __________________________ Email: ____________________
Demographic Information (Check all those that apply.)
Race: Am. Indian/Alaska Nat.___ Asian___ Black/African Am.___ Nat. Hawaiian/Pacific Is.___ White___ Ethnicity: Hispanic/Latino___ Caribbean descent___ Gender: Male___ Female___ Do you speak a language other than English at home? Yes ___ No ____ Language: _______________________ Do you participate in the Free or Reduced Price Lunch Program at your school? Yes___ No___
Did your mother complete a four-year college degree? Yes___ No___ Did your father complete a four-year college degree? Yes___ No___
Medical Information
Please list any special medical conditions or allergies that we should be aware of: _________________________ Do you need any special accommodations to fully utilize the Teen Tech Center? Yes___ No___
If yes, please list needed accommodations: _________________________________________________ Doctor’s Name: ______________________________ Phone: _______________________________________ Insurance coverage (company and policy number): _________________________________________________
Parent/Guardian 1:
First Name: _________________________________ Last Name: ___________________________________ Address (if different than student): _______________________________________________________________ City: _______________________________________ State: ____________ ZIP/Postal Code: ____________ Work: _________________________ Cell: __________________________ Email: ____________________ Relationship to Member: __________ May we contact you in case of an emergency? Yes___ No___
Parent/Guardian 2:
Parent/Guardian Permission Form
Dear Parent/Guardian:
The Best Buy Teen Tech Center is designed to be a safe and fun place for young people from all different kinds of backgrounds. This Permission Form describes the Teen Tech Center and lists the personal information that young people provide to participate.
Program Description
The Teen Tech Center provides a creative and safe after-school learning environment. The Teen Tech Center enables young people to work with adult mentors to explore their own interests, develop skills, and build confidence in themselves through the use of technology. In the Teen Tech Center, young people can design their own music, art, videos, animations, robots, and science simulations. Under the supervision of the Teen Tech Center Coordinator, they have access to the Internet and can occasionally post their own original work on the Internet. The Teen Tech Center is a part of the Intel Computer Clubhouse Network.
What Information We Collect
The Teen Tech Center will collect contact and demographic information on a separate Registration Form as information for the program. When young people participate in the program, they sign in so we know how many young people attended and how often they attend. Also, participants in the Teen Tech Center will have the ability to create materials that may be posted to a Computer Clubhouse Intranet website, called The Computer Clubhouse Village (“The Village”). These materials may contain personal information including, but not limited to, first name, e-mail address, and photograph. The Village is password protected, meaning only Teen Tech Center participants, Intel Computer Clubhouse Network members and staff have passwords and can look at the site. Also, under the supervision of the Tech Center Coordinator, participants in the program may be invited to post content to the Internet. The Teen Tech Center staff educates young people about the dangers of posting personal information (such as last name, e-mail address, or photograph) on the Internet. The Teen Tech Center discourages children from posting personal information on the Internet, but does not control all such content. It is necessary for each child’s parents to instruct their child on the dangers of posting personal information on the Internet. To read the Village Privacy Policy please visit: http://www.computerclubhouse.org/privacy_policy.html
How We Use the Information
The Teen Tech Center uses the information collected to create a list of participants in the program and how often they participate, and to allow participants to share the materials they create. The Teen Tech Center will not transfer or sell this information to any third party. The Teen Tech Center will provide reasonable security for this information and will allow you the opportunity to review this information by contacting the Teen Tech Center Coordinator (see contact information below).
Consent and Release
I am the parent or legal guardian of __________________________________ (child’s name). I give my consent for my child to participate in the Teen Tech Center at the Miami Science Museum. I understand that the Museum of Science, Inc. and all of its trustees, officers, staff, and agents shall take reasonable steps to protect my child from injury. I consent for my child to participate knowing that some risk is involved. I release and hold harmless the Museum of Science, Inc., its trustees, officers, staff, and agents from any responsibility for personal injury or loss which may occur during my child’s activities as a participant in Museum activities except for any injury or loss which may occur because of intentional or gross negligence on the part of such trustees, officers, staff or agents.
Emergency Medical Release
In case of an emergency, the Miami Science Museum has permission to take my child to the nearest medical facility for treatment.
Media Release
I give my consent to Miami Science Museum, Intel Computer Clubhouse Network, and Best Buy the absolute right and permission to use and publish photographs of ______________________________ (child’s name) for any purpose whatsoever, photographs, films, tape and images taken of or created by him/her as a Teen Tech Center member. I understand that the photograph(s) may be used in a publication, print ad, direct-mail piece, electronic media (e.g. video, CD-ROM, Internet, World Wide Web) or other form of promotion or communication, without compensation for usage. I release the Museum, Intel, the Intel Computer Clubhouse Network, Best Buy, and the photographer, their officers, employees, agents, and designees from liability for any infringement of any personal or proprietary right I may have in connection with such use.
By signing this form, I am attesting that I have read and understand the information above and I freely give permission for my child to participate in the Best Buy Teen Tech Center at the Miami Science Museum.
