2020 Summer Adventure Day Camps Registration Form

MEMBER INFORMATION

Full Name *

First

Last

Birth Date (Month/Day/Year) *

Physical Address (If different from mailing address.)

Address Line 1

City

State / Province / Region

Postal Code

Mailing Address *

Address Line 1

City

State / Province / Region

Postal Code

Gender *

Boy
Girl
Non-binary

School *

Health Card Number *

Siblings Who Are Members

Background Information (Voluntary): To support BGCB in tracking progress, statistics, and applying for funding, please check if any of the below categories apply to you.

Country of Origin:

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1 Name *

First

Last

Relation to Member *

Employer *

Phone Number *

Cell Number *

Email *

Parent/Guardian #2 Name

First

Last

Relation to Member

Employer

Phone Number

Cell Number

EMERGENCY CONTACT INFORMATION

*Please provide two emergency contacts other than the parents/guardians listed above. *

Emergency Contact #1 Name *

First

Last

Relation to Member *

Phone Number *

City of Residence *

Address Line 1

City

State / Province / Region

Emergency Contact #2 Name *

First

Last

Relation to Member *

Phone Number *

City of Residence *

Address Line 1

City

State / Province / Region

MEDICAL INFORMATION

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

Select all those that apply. *

Allergies
Medical
Learning/Behavioral
Other (Any additional information which may assist your child in positively participating in our programs.)
None of the above.

Allergies

Medical

Learning/Behavioural

Other (Any additional information which may assist your child in positively participating in our programs.)

CONTRACT AGREEMENT

Please indicate the week(s) you would like your child to participate in:

CAMP DETAILS

Hours of Operations: Monday-Friday 7:45am-5:30pm

We are pleased to announce that again this year, we will be offering our Lunch Program FREE OF CHARGE! Along with a meal, participants will receive a morning & afternoon snack daily. Our extended hours (7:45am-8:30am and 4:30pm-5:30pm) are also being offered again this year FREE OF CHARGE! To adhere to provincial guidelines, there will be a limit of 15 children accepted per week due to COVID-19. Unfortunately, this means that we will only be accepting the first 15 registrations (both forms and payments must be received) and cannot guarantee that there will be space remaining. There will be a cancellation list in case someone is not able to attend their chosen week, in which case we will be in contact with parents/guardians in the order that registrations were received.

PAYMENTS

Our weekly rate is $120.

*Although we will see increased costs to operate, this year we are offering our Summer Adventure Day Camps at a slightly reduced weekly rate of $120.00. We made this decision knowing the financial impact COVID-19 has had on many, combined with the fact we have cancelled our weekly field trips. * Please note, the fee for Week 5 (August 4th - 7th) will be $100.00 due to the stat holiday.

Payment is due IN FULL UPON REGISTERING for our Summer Adventure Day Camps. If we do not receive the full payment upon registration, we cannot guarantee that a space will be available for your child.

Payment methods: Given our COVID-19 procedures, we would like to encourage the use of e-transfers. E-transfers can be sent to ac.bcgb@stnemyap . Please include the child’s full name in the memo section. BGCB is set up for automatic deposit of e-transfers which means no password is required. When e-transfer is not available, the other forms of payment accepted at the office are: cash, debit or credit.

CHANGES AND CANCELLATION POLICY

By signing this agreement, you are committing to this contract for the 2020 Summer Adventure Day Camps. Families are required to provide ONE WEEK’S NOTICE for any changes to this agreement in writing by completing a Contract Amendment Form. ALL CHANGES/CANCELLATIONS MUST BE SUBMITTED PRIOR TO 12:00pm (NOON) MONDAY OF THE WEEK PRIOR TO THE CHANGES BEING REQUESTED. Please contact the office to request this form or visit our website (www.bgcbattlefords.ca). Refunds will be issued on August 24, 2020 only if required notice has been received.

Changes & Cancellation Agreement -NAME *

First

Last

CUSTODY AND/OR COURT ORDER

Custody & Related Court Orders: *

Not Applicable
See Below

If a custody or court order exists, a copy of the order must be given to Boys & Girls Clubs of The Battlefords. The parent/guardian is responsible for providing accurate and up to date information concerning the legal guardianship of the child. Without a custody or court order on file, Boys & Girls Clubs of The Battlefords cannot deny access to the non-enrolling parent.

Please list anyone who is NOT ALLOWED to pick up your child (If applicable.):

Custody & Court Order Acknowledgement- NAME *

First

Last

Date (m/d/y) *

MEDIA CONSENT & RELEASE

Boys & Girls Clubs of The Battlefords has the right to use any artwork, photographs, video, and/or audio of my child while participating in Summer Adventure Day Camps activities for the purpose of advertisement and promotional campaigns in the future. *

Yes, I agree.
No, I do not agree.

Media Consent & Release -NAME *

First

Last

REGISTRATION AGREEMENT

Parents/Guardians: Please review these guidelines/rules with your child. If you want to participate in Boys & Girls Clubs of The Battlefords (BGCB) Summer Adventure Day Camps and enjoy the activities they have planned, you have to agree to respect the staff, volunteers, and the other children. YOU MUST UNDERSTAND THAT BGCB IS A SAFE PLACE FOR ALL CHILDREN, 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 follow these rules, you may lose your privileges as a result and may not be able to return to Summer Adventure Day Camps in the future.

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

• I understand that my child is being asked to abide by the rules of BGCB. Should my child not abide by these rules, I agree to work with the staff of BGCB to help resolve the situation. *

• I understand that BGCB staff and volunteers will be supervising club activities and programs during the Summer Adventure Day Camps hours of operation, and that it is my responsibility as parent/guardian to ensure my child’s safety before and after the hours of operation. *

• Although every effort is made to keep the children for the full length of Summer Adventure Day Camps hours, I understand that my child may leave the premises of BGCB at his/her own will, and that I will make every effort to communicate with my child when he/she is to leave BGCB. *

• I understand that should my child not be picked up prior to the closing hours of BGCB, the staff may be in contact with authorities such as the Battlefords RCMP and/or Social Services. *

• I agree that under no circumstances are BGCB staff members, volunteers or board members responsible for lost or stolen belongings. *

• I understand that should any of the activities during Summer Adventure Day Camps occur away from the main site of BGCB, BGCB will provide transportation and separate permission forms will be required. *

• With full knowledge of the existence and nature of my legal right and in consideration for the opportunities provided to my child by BGCB, I waive my legal right against BGCB, its staff, volunteers, or Board of Directors for any injury or damage suffered during or by reason of practicing, participating or assisting in a club service, program, or experience. *

• I further authorize the application of emergency medical attention and undertake to be responsible for any hospitalization, medical, ambulance or other expenses. *

Registration Agreement -NAME *

First

Last

Registration Agreement- Date & Time *

Date

Time

Comment