2022 membership form

2022 Membership Form

Please fill out one form for each child attending.

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 child have any special needs/requirements in the following areas? If yes, please explain further and 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 child. Without a custody or court order on file, BGC Battlefords cannot deny access to the non-enrolling parent.

PAYMENT

Our Annual Membership fee is $5 - this is due upon completing this membership form. With the membership fee, your child gains access to all programming offered at BGC Battlefords' Main Site, Summer Parks Drop-in Programs, as well as all Special Programs (ex: Hockey Program, Music Program, Soccer Program).

Payment Methods:

E-transfers can be sent to ac.bcgb@stnemyap. Please indicate the child'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. Office hours are Monday-Friday from 8:30am-3:30pm.

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 Participation Code of Conduct with your child.

If you want to become a member of BGC Battlefords (BGCB) and enjoy the privileges a member has, you must agree to respect the staff, volunteers, other members, yourself, the building, and the equipment. YOU MUST UNDERSTAND THAT BGCB IS A SAFE PLACE FOR ALL MEMBERS, AND IF YOU ACT IN A WAY THAT MAKES SOMEONE FEEL UNSAFE OR BULLIED, YOU WILL BE ASKED TO LEAVE. You will follow the rules set by the staff. You also understand that if you do not abide by these rules, you may lose your privileges and may not be able to return to BGCB in the future.

BGC Battlefords' Rules:

Use your listening ears. | Be kind to everyone. | Join in today's activities. | Be gentle with Club property. | Help with clean up. | Keep your hands and feet to yourself. | Lend a hand. | Be polite & respectful. | HAVE FUN!

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

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

This membership is valid from January 1st, 2022 to December 31st, 2022. Membership Fee is $5.00 per child. Membership Fee is non-refundable. Summer Parks Drop-in Program is FREE OF CHARGE. Membership fee is waived for July and August. 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.