Membership Form

Description of the Program

The Clubhouse provides a creative and safe after-school learning environment for young people ages 14-18. The Clubhouse enables young people to work with adult mentors to explore their own interests, develop skills, and build confidence in themselves through the use of STEAM (Science, Technology, Engineering, Arts, and Math). In the Clubhouse, young people can design their own music, art, videos, animations, robots, and science simulations. Under the supervision of the Clubhouse Coordinator, Kahmal London, they have access to the Internet and can occasionally post their own original work on the Internet through a shared platform. We also provide opportunities for youth to host events to showcase their talents and assist them with workforce readiness skills.

What Information We Collect

The Clubhouse will collect the information on this form as registration information for the program. When young people participate in the program, they sign in so that the Clubhouse knows how many young people attended and how often. Also, participants in the Clubhouse will have the ability to create projects that may be posted to a Clubhouse Intranet website, called “The Clubhouse Village.” These projects may contain personal information including, but not limited to, first name, e-mail address, and photograph. “The Clubhouse Village” is password-protected, meaning only Clubhouse participants and staff have passwords and can look at the site. The Clubhouse staff educates young people about the dangers of posting personal information (such as last name, e-mail address, or photograph) on the Internet. It is necessary for each member’s parents to instruct them on the dangers of posting personal information on the Internet. To read the Village Privacy Policy please visit:

How We Use the Information

The Clubhouse 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 projects they create. The Clubhouse will not transfer or sell this information to any third party. The Clubhouse will provide reasonable security for this information and will allow you the opportunity to review this information by contacting the Clubhouse staff.