Summer Adventure Day Camps - BGC Battlefords

2022 summer adventure day camps registration form

2022 Summer Adventure Day Camps Registration Form

MEMBER INFORMATION

Child's Full Name (First/Middle/last) *

Date of Birth (Month/Day/Year) *

Physical Address *

Address Line 1

City

State / Province / Region

Postal Code

Mailing Address (If different from Physical Address)

Address Line 1

City

State / Province / Region

Postal Code

Gender *

Male
Female
Non-binary

School & Grade *

Siblings Who Are Members

Is this child in Foster Care? *

If yes, name of childcare worker:

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.

Country of Origin:

Primary Language(s) Spoken:

Secondary Language(s) Spoken:

Family Setting (Primary Residence)

Two Parent/Guardian Household
One Parent/Guardian Household

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1 Name *

First

Last

Relation to Member *

Primary Phone Number *

Email Address *

Employer *

Parent/Guardian #2 Name

First

Last

Relation to Member

Primary Phone Number

Email Address

Employer

EMERGENCY CONTACT INFORMATION

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

Emergency Contact #1 Name *

First

Last

Relation to Member *

Primary Phone Number *

City of Residence *

Emergency Contact #2 Name *

First

Last

Relation to Member *

Primary Phone Number *

City of Residence *

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.

Select all those that apply. *

Allergies
Medical Condition(s)
Learning/Behavioral Needs
Disability (Physical Disability or Cognitive Disability such as: ADHD, FASD, etc.)
Other (Any additional information which may assist your child in positively participating in our programs.)
None of the above.

Allergies

Medical Condition(s)

Learning/Behavioral Needs

Disability

Other (Any additional information which may assist your child in positively participating in our programs.)

PLEASE NOTE: The safety of your child is of utmost importance to us. Therefore, until BGC Battlefords staff become familiar with the child's parents/guardians, you will be asked for a release password or government issued photo ID. Anyone picking up the child other than the parents/guardians will be asked for the same release password or their government issued photo ID. We kindly ask parent/guardians to notify our staff if anyone other than themselves will be picking the child up. Please indicate your RELEASE PASSWORD below: *

CONTRACT AGREEMENT

Please indicate the week(s) you would like your child to participate in:

Please indicate the day(s) you would like your child to participate in:

Week 1 July 4, 5, 6, 7, 8 ($45/day)

Week 2: July 11, 12, 13, 14, 15 ($45/day)

Week 3: July 18, 19, 20, 21, 22 ($45/day)

Week 4: July 25, 26, 27, 28, 29 ($45/day)

Week 5: August 2, 3, 4, 5 ($45/day)

Week 6: August 8, 9, 10, 11, 12 ($45/day)

Week 7: August 15, 16, 17, 18, 19 ($45/day)

Week 8: August 22, 23, 24, 25, 26 ($45/day)

CAMP DETAILS

Hours of Operation

Monday to Friday from 7:30am - 5:30pm (CLOSED Monday August 1st)

Age:

Children must be 5 to 14 years old to attend our camps.

Field Trips:

We are offering our field trips this year FREE OF CHARGE! Field trips will be based on the theme for the week and will take place on Thursday every week. Additional permission forms will be required to participate in the field trips.

Snacks & Meals:

Included in our camp registration fee, is a breakfast, lunch, and afternoon snack daily. Our extended hours (7:30am-8:30am and 4:30pm-5:30pm) are also being offered again this year FREE OF CHARGE!

PAYMENTS

Our weekly rate is $130.

Please note, the fee for Week 5 (August 2nd-5th) will be $110.00 due to the stat holiday on Monday August 1st.

Our daily rate is $45.

Please note, we are CLOSED on Monday, August 1st, 2022.

Payment is due one week before the childs’ attendance at camp. If we do not receive the full payment one week in advance, the child will not be able to participate in the Summer Adventure Day Camp.

Payment methods: Given our COVID-19 procedures, we would like to encourage the use of e-transfers. E-transfers can be sent to ac.bcgb@stnemyap. Please include 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.

CHANGES TO CONTRACT AND CANCELLATION POLICY

By signing this agreement, you are committing to this contract for the 2022 Summer Adventure Day Camps. Families are required to provide ONE WEEK’S NOTICE for any changes to this agreement in writing by completing a Contract Amendment Form.

ALL CHANGES/CANCELLATIONS MUST BE SUBMITTED PRIOR TO 12:00pm (NOON) MONDAY OF THE WEEK PRIOR TO THE CHANGES BEING REQUESTED. Please contact the office to request this form or visit our website (www.bgcbattlefords.ca). Refunds will be issued by September 30th, 2022 only if required notice has been received.

Changes & Cancellation Agreement -NAME *

First

Last

Changes & Cancellation Agreement - DATE *

CUSTODY & RELATED COURT ORDERS

Custody & Related Court Orders: *

Not Applicable
See Below

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.

Please list anyone who is NOT ALLOWED to pick up your child (If applicable.):

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.

Custody & Court Order Acknowledgement- NAME *

First

Last

Custody & Court Order Acknowledgement -DATE *

MEDIA CONSENT & RELEASE

BGC Battlefords has the right to use any artwork, photographs, video, and/or audio of my child while participating in Club activities for the purpose of advertisement and promotional campaigns in the future. My child’s 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 a child’s image without written permission of the parent/guardian. *

Yes, I agree.
No, I do not agree.

Media Consent & Release -NAME *

First

Last

Media Consent & Release -DATE *

ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO COVID-19

Parents/Guardians please read:

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.

Waiver of Liability Relating to COVID-19 - NAME *

First

Last

Waiver of Liability Relating to COVID-19 - DATE *

REGISTRATION AGREEMENT

Parents/Guardians, please review these guidelines/rules with your child:

If you want to participate in BGC Battlefords (BGCB) Summer Adventure Day Camps and enjoy the activities they have planned, you must agree to respect the staff, volunteers, and the other children. YOU MUST UNDERSTAND THAT BGCB IS A SAFE PLACE FOR ALL CHILDREN, AND IF YOU ACT IN A WAY THAT MAKES SOMEONE FEEL UNSAFE, YOU WILL BE ASKED TO LEAVE. You will follow the rules set by the staff. You also understand that if you do not follow these rules, you may lose your privileges as a result and may not be able to return to Summer Adventure Day Camps in the future.

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

• I understand that my child is being asked to abide by the rules of BGCB. Should my child not abide by these rules, I agree to work with the staff of BGCB to help resolve the situation. *

• I understand that BGCB staff and volunteers will be supervising club activities and programs during the Summer Adventure Day Camps hours of operation, and that it is my responsibility as parent/guardian to ensure my child’s safety before and after the hours of operation. *

• I understand that should my child leave the Summer Adventure Day Camps before authorized to do so by a parent/guardian and/or staff, staff will make all reasonable efforts to contact me. I further understand that once my child has left the camp premises, the staff, volunteers, and Board of Directors, are not liable for my child. *

• Although every effort is made to keep the children for the full length of Summer Adventure Day Camps hours, I understand that my child may leave the premises of BGCB at his/her own will, and that I will make every effort to communicate with my child when he/she is to leave BGCB. *

• I understand that should my child not be picked up prior to the closing hours of BGCB, the staff may be in contact with authorities such as the Battlefords RCMP and/or Social Services. *

• I agree that under no circumstances are BGCB staff, volunteers, or Board of Directors, responsible for lost or stolen belongings. *

• I understand that should any of the activities during Summer Adventure Day Camps occur away from the main site of BGCB, BGCB will provide transportation and separate permission forms will be required. *

• With full knowledge of the existence and nature of my legal right and in consideration for the opportunities provided to my child by BGCB, I waive my legal right against BGCB, its staff, volunteers, or Board of Directors for any injury or damage suffered during or by reason of practicing, participating or assisting in a club 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. *

Registration Agreement -NAME *

First

Last

Registration Agreement- Date & Time *

Date

Time

*If you would like your child to walk/bike to and/or from our Summer Adventure Day Camps, you will be required to fill out an additional permission form. Please contact the office to receive this form.

*If your child requires the use of any medications (for allergies, medical conditions, etc.) while participating in Summer Adventure Day Camps, separate medical/permission forms will be required. Please contact the office to receive these forms.

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

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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