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Donors ($1-$499)
FORMS
BGC Battlefords Newsletter Sign Up
2022 Scott Campbell Dodge Race for Kids REGISTRATION FORM
2022 Scott Campbell Dodge Race for Kids PLEDGE FORM
2022 Race for Kids EVENT SPONSORSHIP FORM
2022 Volunteer Application Form
2022 Summer Adventure Day Camps Registration Form
2022 Summer Adventure Day Camps Contract Amendment Form
2022 Summer Adventure Day Camps Subsidy Application Form
2022 Membership Form
2021-2022 Bready Before & After School Program Membership Form
2021-2022 EMBM Before & After School Program Membership Form
2021-2022 Holy Family After School Program Membership Form
2021-2022 Satellite Site Contract Amendment Form
2021-2022 Raise the Grade Program Registration Form
2021 Project Backpack Program Registration Form
2022 Take It EASY Program Registration Form
ANNUAL EVENTS
BGC Club Day
Gala
Pink Shirt Day
Race For Kids
CONTACT US
DONATE
Menu
HOME
ABOUT US
Our Team
Annual Reports
Health & Safety
Work For Us
PROGRAMS
Main Site Programs
Satellite Site Programs
Summer Programs
Special Programs
DONORS
Champions ($50,000+)
Major Funders ($20,000-$49,999)
Builders ($10,000-$19,999)
Changemakers ($5,000-$9,999)
Partners ($1,000-$4,999)
Supporters ($500-$999)
Donors ($1-$499)
FORMS
BGC Battlefords Newsletter Sign Up
2022 Scott Campbell Dodge Race for Kids REGISTRATION FORM
2022 Scott Campbell Dodge Race for Kids PLEDGE FORM
2022 Race for Kids EVENT SPONSORSHIP FORM
2022 Volunteer Application Form
2022 Summer Adventure Day Camps Registration Form
2022 Summer Adventure Day Camps Contract Amendment Form
2022 Summer Adventure Day Camps Subsidy Application Form
2022 Membership Form
2021-2022 Bready Before & After School Program Membership Form
2021-2022 EMBM Before & After School Program Membership Form
2021-2022 Holy Family After School Program Membership Form
2021-2022 Satellite Site Contract Amendment Form
2021-2022 Raise the Grade Program Registration Form
2021 Project Backpack Program Registration Form
2022 Take It EASY Program Registration Form
ANNUAL EVENTS
BGC Club Day
Gala
Pink Shirt Day
Race For Kids
CONTACT US
DONATE
2022 Membership Form
2022 membership form
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2022 Membership Form
Please fill out one form for each child attending.
MEMBER INFORMATION
Member's Name
*
First
Last
Date of Birth (month/date/year)
*
Physical Address (If different from mailing address.)
Address Line 1
City
State / Province / Region
Mailing Address
*
Address Line 1
City
State / Province / Region
Postal Code
Gender
*
Male
Female
Non-binary
School
*
Grade
*
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.
First Nations
Metis
Francophone
ESL (English Second Language)
New Canadian
Immigrant
Country of Origin:
Primary Language(s) Spoken
*
Secondary Language
Family Setting (Primary Residence)
*
Two Parent/Guardian Household
One Parent/Guardian Household
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 Information
Parent/Guardian #1 Name
*
First
Last
Relation to Member
*
Employer:
*
Phone Number
*
Cell Number
*
Email
*
Parent/Guardian #2 Information
Parent/Guardian #2 Name
First
Last
Relation to Member
Employer
Phone Number
Cell Number
Email
EMERGENCY CONTACTS
Please provide two emergency contacts OTHER THAN the parents/guardians listed above.
Emergency Contact #1
*
First
Last
Relation to Member
*
Phone Number
*
City of Residence
*
Emergency Contact #2
*
First
Last
Relation to Member
*
Phone Number
*
City of Residence
*
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.
Select all those that apply.
*
Allergies
Medical Condition(s)
Learning/Behavioral Needs
Cognitive Disability (Such as: ADHD, FASD, etc.)
Physical Disability
Other Considerations (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
Cognitive Disability
Physical Disability
Other Considerations (Any additional information which may assist your child in positively participating in our programs.)
CUSTODY AND/OR COURT ORDER
Custody and/or Court Order
*
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:
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 And/Or Court Order - NAME
*
First
Last
Custody And/Or Court Order - DATE (month/day/year)
*
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
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 (month/day/year)
*
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.
COVID-19 Waiver -NAME
*
First
Last
COVID-19 Waiver -DATE (month/day/year)
*
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:
• I understand that my child is being asked to abide by the Participant Code of Conduct of BGCB. Should my child not abide by these guidelines, I agree to work with the staff of BGCB to help resolve the situation.
*
• I understand that BGCB staff and volunteers will be supervising activities and programs during the 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 BGCB premises 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 BGCB premises, the staff, volunteers, and Board of Directors, are not liable for my child.
*
• 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 further understand that my child has my permission to attend programs offered through BGCB, some of which will require transportation to another location.
*
• 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 BGCB 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.
*
Membership Agreement - NAME
*
First
Last
Membership Agreement - DATE & TIME
*
Date
Time
*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.
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