2021-2022 raise the grade program registration form

2021-2022 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 teen 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.

CUSTODY AND/OR COURT ORDER

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

I have provided BGC Battlefords with legal documentation (custody or court order). Without this, BGC Battlefords cannot legally deny access to a non-enrolling parent.

PAYMENT

Raise the Grade registration fee is $5 - this is due upon completing the registration form. With the registration fee your teen gains access to all the benefits and opportunities offered through Raise the Grade. These include but are not limited to mentorship, academic help, career planning, and meals.

Payment Methods:

E-transfers can be sent to ac.bcgb@stnemyap. Please include the teen's full name in the memo section. BGC Battlefords 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.

MEDIA CONSENT & RELEASE

REGISTRATION CONTRACT

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

If your teen wants to participate in BGC Battlefords (BGCB) Raise the Grade Program and enjoy the privileges as a participant, you have to agree that your teen will respect the staff, volunteers, and the other members. YOU MUST UNDERSTAND THAT RAISE THE GRADE IS A SAFE PLACE FOR ALL PARTICIPANTS, AND IF YOUR TEEN ACTS IN A WAY THAT MAKES SOMEONE FEEL UNSAFE, THEY WILL BE ASKED TO LEAVE. Your teen will follow the rules set by the staff. You also understand that if your teen does not abide by these rules, they may lose their privileges as a result and may not be able to return to Raise the Grade and/or BGCB in the future.

Parents/Guardians please read and initial beside the following statements agreeing to:

BGC Battlefords is committed to protecting the confidentiality of personal information. The information collected will assist BGC Battlefords in service delivery and is kept confidential.