2021 Summer Adventure Day Camps Registration Form

MEMBER INFORMATION

Child's Full Name *

First

Last

Birth Date (Month/Day/Year) *

Physical Address (If different from mailing address.)

Address Line 1

City

State / Province / Region

Postal Code

Mailing Address *

Address Line 1

City

State / Province / Region

Postal Code

Gender *

Male
Female
Non-binary

School *

Health Card Number *

Siblings Who Are Members

Background Information (Voluntary): To support BGCB in tracking progress, statistics, and applying for funding, please check if any of the below categories apply to you.

Country of Origin:

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1 Name *

First

Last

Relation to Member *

Employer *

Phone Number *

Cell Number *

Email *

Parent/Guardian #2 Name

First

Last

Relation to Member

Employer

Phone Number

Cell Number

EMERGENCY CONTACT INFORMATION

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

Emergency Contact #1 Name *

First

Last

Relation to Member *

Phone Number *

City of Residence *

Emergency Contact #2 Name *

First

Last

Relation to Member *

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
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

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

PLEASE NOTE: The safety of your child is of upmost importance to us. Therefore, until BGCB 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. Please indicate your RELEASE PASSWORD below: *

CONTRACT AGREEMENT

*Daily rates of $45/day may be offered based on availability of spaces. For more information on the availability, please contact the office at (306) 445-0002 or ac.bcgb@ofni

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

CAMP DETAILS

Hours of Operation: Monday to Friday from 7:45am - 5:30pm (CLOSED Monday August 23rd)

Capacity:

To adhere to provincial COVID-19 guidelines, there will be a limit of 15 children per floor per day. Children and Youth will be placed into two groups (one group per floor) based on the ages and needs of those registered for the week. Unfortunately, this means that we will only be accepting the first 30 registration forms per week (both forms and payments must be received to secure the spot) and cannot guarantee that there will be space remaining. There will be a cancellation list in case someone is not able to attend their chosen weeks, in which case we will be in contact with parents/guardians in the order that registrations were received.

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. Field trips may be cancelled without notice depending on Government of Saskatchewan and the facilities directions with regards to COVID-19.

Snacks & Meals:

We will be offering our Lunch Program FREE OF CHARGE! Along with a meal, participants will receive a morning & afternoon snack daily. Our extended hours (7:45am-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 3rd-6th) will be $110.00 due to the stat holiday on Monday August 2nd.

Payment is due IN FULL UPON REGISTERING for our Summer Adventure Day Camps. If we do not receive the full payment upon registration, we cannot guarantee that a space will be available for your child.

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. BGCB 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 2021 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, 2021 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 Boys & Girls Clubs of The 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, Boys & Girls Clubs of The 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 Boys & Girls Clubs of The Battlefords with legal documentation (custody or court order). Without this, BGCB cannot legally deny access to a non-enrolling parent.

Custody & Court Order Acknowledgement- NAME *

First

Last

Custody & Court Order Acknowledgement -DATE *

MEDIA CONSENT & RELEASE

Boys & Girls Clubs of The Battlefords has the right to use any artwork, photographs, video, and/or audio of my child while participating in Summer Adventure Day Camps activities for the purpose of advertisement and promotions in the future. *

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

Media Consent & Release -NAME *

First

Last

Media Consent & Release -DATE *

REGISTRATION AGREEMENT

Parents/Guardians: Please review these guidelines/rules with your child.

If you want to participate in Boys & Girls Clubs of The 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 initialing 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. *

• 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 members, volunteers or board members 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 medications (for allergies, medical conditions, etc.) while participating in Summer Adventure Day Camps, separate medical/permissions 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

Name