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Menu
HOME
ABOUT US
Learn About Us
Our Team
Annual Reports
Health & Safety
Work For Us
PROGRAMS
Main Site Programs
Satellite Site Programs
Summer Programs
Special Programs
DONORS
Champions ($50,000+)
Major Funders ($20,000-$49,999)
Builders ($10,000-$19,999)
Changemakers ($5,000-$9,999)
Partners ($1,000-$4,999)
Supporters ($500-$999)
Donors ($1-$499)
FORMS
BGC Battlefords Newsletter Sign Up
2022 Volunteer Application Form
2022 Summer Adventure Day Camps Registration Form
2022 Summer Adventure Day Camps Contract Amendment Form
2022 Summer Adventure Day Camps Subsidy Application Form
2022 Membership Form
ANNUAL EVENTS
BGC Club Day
Gala
Pink Shirt Day
Race For Kids
CONTACT US
DONATE
2021-2022 Raise the Grade Program Registration Form
2021-2022 raise the grade program registration form
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2021-2022 Raise the Grade Registration
MEMBER INFORMATION
Full Name
*
First
Last
Date of Birth (Month/Day/Year)
*
Phone Number
*
Email Address
*
Physical Address
*
Address Line 1
City
State / Province / Region
Gender
*
Male
Female
Non-binary
School
*
Grade
*
Background Information (Voluntary): To support BGC Battlefords in tracking progress, statistics, and applying for funding, please check if any of the below categories apply to you.
First Nations
Metis
Francophone
ESL (English Second Language)
New Canadian
Immigrant
Visible Minority
Country of Origin:
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 Information
Parent/Guardian #1 Name
First
Last
Relation to Member
Phone Number
Parent/Guardian #2 Information
Parent/Guardian #2 Name
First
Last
Relation to Member
Phone Number
MEDICAL INFORMATION
Do you have any needs/requirements, allergies or medical conditions that you would like to share with us?
MEDIA CONSENT & RELEASE
BGC Battlefords has the right to use any artwork, photographs, video, and/or audio of me while participating in Club activities for the purpose of advertisement and promotional campaigns in the future. My image may be published or used in newspapers, promotional videos, television commercials, television news items, program brochures, posters, social media sites, etc. or otherwise displayed to the public or used for other educational/fundraising purposes, either in whole or in part by BGC Battlefords, BGC Canada and/or external partners. No names will ever be used in association with my image without my written permission.
*
Yes, I agree.
No, I do not agree.
Media Consent - NAME
*
First
Last
Media Consent - DATE
*
ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY TO COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is contagious and is believed to spread mainly from person-to-person contact. BGC Battlefords has put in place procedures to reduce the spread of COVID-19. Regardless of the precautionary measures in place, BGC Battlefords cannot guarantee that you or your child(ren) will not become infected with COVID-19. All program guidelines are subject to change with no notice upon government recommendations and requirements. Attending BGC Battlefords programs could increase your risk and your child(ren)’s risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending BGC Battlefords programs and that exposure or infection may result in injury, illness, health complications or death. I understand that the risk of becoming exposed to or infected by COVID-19 at BGC Battlefords programs may result from the actions or omissions of myself and others, including, but not limited to, BGC Battlefords’ employees and program participants, and their families. By my signature, I confirm that I have read and understand the COVID-19 Procedures as posted on the BGC Battlefords website (https://www.bgcbattlefords.ca/covid-19-information/) or as shown to me in-person.
I voluntarily agree to assume all risks and accept sole responsibility for any issues or complications my child(ren) or myself may experience or incur in connection with my child(ren)’s attendance and participation in BGC Battlefords programming. On my behalf, and on behalf of my children, I hereby release and hold harmless BGC Battlefords (legal name, Battlefords Boys and Girls Club), its employees, the program facility and all representatives from all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating to it. I understand and agree that this release includes any claims based on the actions, or omissions of BGC Battlefords, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any BGC Battlefords program.
COVID Waiver -NAME
*
First
Last
COVID Waiver -DATE
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REGISTRATION CONTRACT
Please review these guidelines/rules and initial beside the following statements agreeing to:
• I must understand that Raise the Grade is a safe place for all participants, and if I act in a way that makes someone feel unsafe, I will be asked to leave.
*
• I understand that I may be working closely with a volunteer mentor. All mentors have undergone a screening process and have been specifically paired with me based on my interests and goals.
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• I agree that under no circumstances are BGCB staff members, volunteers, or board members responsible for my lost or stolen belongings.
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• With full knowledge of the existence and nature of my legal right and in consideration for the opportunities provided to me by BGCB and Raise the Grade, I waive my legal right against BGCB, its staff, volunteers, and/or Board of Directors for any injury or damage suffered during or by reason of practicing, participating or assisting in a BGCB 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.
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Membership Agreement - NAME
*
First
Last
Membership Agreement - DATE & TIME
*
Date
Time
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.
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