2020-2021 Raise the Grade Registration

MEMBER INFORMATION

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1 Information

Parent/Guardian #2 Information

EMERGENCY CONTACTS

* Please provide two emergency contacts OTHER THAN the parents/guardians listed above. *

MEDICAL INFORMATION

Does your child have any needs/requirements in the following areas? If yes, please explain further and indicate any diagnoses and medications that they are taking.

MEDIA CONSENT & RELEASE

REGISTRATION CONTRACT

Parents/Guardians: Please review these guidelines/rules with your child.

If you want to participate in Boys & Girls Clubs of The Battlefords (BGCB) Raise the Grade Program and enjoy the privileges a participant has, you have to agree to respect the staff, volunteers, and other members. YOU MUST UNDERSTAND THAT BGCB IS A SAFE PLACE FOR ALL MEMBERS, AND IF YOU ACT IN A WAY THAT MAKES SOMEONE FEEL UNSAFE, YOU WILL BE ASKED TO LEAVE. You will follow the rules set by the staff. You also understand that if you do not abide by these rules, you may lose your privileges as a result and may not be able to return to BGCB in the future.

Parents/Guardians please read and agree to, by initialing beside, the following statements: