2021-2022 bready before & after school program membership form

2021-2022 Bready Before & After School Program Membership Form

This membership is valid from September 1st, 2020 to December 31st, 2021. Membership Fee is $5.00 per child. Membership Fee is non-refundable.

MEMBER INFORMATION

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

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

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.
(ex: Physical Disability or Cognitive Disability such as: ADHD, FASD, etc.)
Any additional information which may assist your child positively participating in our programs.

CUSTODY AND/OR COURT ORDER

If a custody 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 child. Without a custody or court order on file, BGC Battlefords cannot deny access to the non-enrolling parent.

IMPORTANT INFORMATION FOR YOU TO KNOW

Please check off to acknowledge that you have read and understand the information below:

IMPORTANT INFORMATION FOR PART-TIME AND CASUAL CONTRACTS

Please check off to acknowledge that you have read and understand the information below:

CONTRACT AGREEMENT

Please choose the service agreement required for your child:

CHANGES TO CONTRACT AND CANCELLATION POLICY

By signing this agreement, you are committing to this service agreement for the 2021-2022 School Year. Please note, changes/cancellations to this agreement require ONE FULL MONTHS’ NOTICE in writing by filling out a Contract Amendment Form prior to the month of service being affected. For example, if you submit the Contract Amendment Form on January 15th, the changes will take effect March 1st and the original contract fee would be owed for January and February. Please contact the office to request this form or visit our website (www.bgcbattlefords.ca). BGC Battlefords reserves the right to terminate this program by also providing one month’s notice to families.

MEDIA CONSENT & RELEASE

ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING 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.

MEMBERSHIP CONTRACT

Parents/Guardians please review the following Participant Code of Conduct with your child:

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

* If you would like a copy of this membership form, please contact the office at 306-445-0002 or ac.bcgb@ofni. *