2021-2022 embm before & after school Program membership form

2021-2022 EMBM 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. Families are required to provide ONE MONTH'S NOTICE for any changes to this agreement in writing by filling out a Contract Amendment Form. 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

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. *