2023-2024 EMBM Before & After School Program Membership Form

2023-2024 embm before & after school program membership form

2023-2024 EMBM Before & After School Program Membership Form

MEMBER INFORMATION

Child's Full Name: *

First

Middle

Last

Child's Birthday: *

Physical Address:

Address Line 1

City

State / Province / Region

Mailing Address: *

Address Line 1

City

State / Province / Region

Postal Code

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 your child.

Country of Origin:

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1

Parent/Guardian #1 Name: *

First

Last

Relation to Member: *

Primary Phone Number: *

Alternate Phone Number:

Email Address: *

Employer:

Parent/Guardian #2 Name:

First

Last

Relation to Member:

Primary Phone Number:

Alternate Phone Number:

Email Address:

Employer:

EMERGENCY CONTACT INFORMATION

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

Emergency Contact #1

Emergency Contact #1 Name: *

First

Last

Relation to Member: *

Primary Phone Number: *

City of Residence: *

Emergency Contact #2

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. If no, please note 'not applicable' on the boxes below.

Allergies: *

Medical Condition(s): *

Learning/Behavioral Needs: *

Does your child have a disability? (ex. Physical Disability or Cognitive Disability such as: ADHD, FASD, etc.) *

If yes, please explain (voluntary):

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

If your child requires the use of any medications (for allergies, medical conditions, etc.) while participating in our programs, separate medical/permission forms will be required. Forms are available online (www.bgcbattlefords.ca) or in person (by visiting the office).

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 attach a copy of the court order to this form or submit via email to ac.bcgb@ofni.

Click or drag a file to this area to upload.

Please list anyone who is NOT ALLOWED to pick up your child:

Custody and/or Court Order

I will provide BGC Battlefords with legal documentation (custody or court order).

Signature of Parent/Guardian

TERMS AND CONDITIONS

• Invoices will typically be sent one month in advance, giving families time to review, send payment, change, or cancel the contract. Invoices for additional visits will be sent the following month, once attendance is complete. For the months with Christmas Break, Winter Break and Easter Break, a reduced rate will only apply to full-time contract members.

• Payments are due prior to the 1st of each service month and children are NOT able to attend the Satellite Site until the account is paid in full.

• Our Annual Membership fee is $5 and will only be included on your first invoice. With the membership fee, your child gains access to all programming offered at BGC Battlefords Main Site including the Non-School Days Program (e.g. Winter Break, PD Days, etc.), as well as our Special Programs (e.g. Lacrosse, Music, Soccer, and more). Summer Parks Drop-in Programs are free for everyone.

• Payment methods: E-transfers can be sent to ac.bcgb@stnemyap. Please include the child(ren)’s name and school 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: Monday to Friday, 8:30am – 3:30pm).

• Full-time contracts: Please contact the office by noon if your child(ren) is/are going to be absent on a given day so that we can update the attendance.

• For Part-time and Casual contracts:

---> Before School Program – please contact the office by noon the day prior to pre-register your child.

---> After School Program - please contact the office by noon to pre-register/update your child’s attendance for that day.

---> You can also return a calendar to our office (which will be emailed monthly), with expected attendance dates for the month.

• By agreeing to this contract, you are committed to the contract and the contract fees regardless of attendance.

• If you would like your child to walk/bike to and/or from our Before & After School Program, you will be required to fill out an additional permission form. Please contact the office to receive this form.

• 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 and/or their government issued photo ID.

Release Password: *

TERMS AND CONDITIONS *

I have read and agree to the above terms and conditions.

Signature of Parent/Guardian: *

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 don't agree

Signature of Parent/Guardian: *

CONTRACT AGREEMENT

Please choose the service agreement required for your child:

BEFORE SCHOOL CARE (7:30am – 8:30am): *

Full-time – child can attend the program on all school days (approximately 20 days per month) - $125/month
Part-time – child can attend the program a max of 12 days/month - $80/month
Casual – child can attend the program a max of 5 days/month - $35/month
I do not require before school care

*If you require extra visits (beyond the 5 or 12 max days per month), additional care will be provided at a rate of $10/visit.

AFTER SCHOOL CARE (Class dismissal to 5:30pm, open early on Early Dismissal Days): *

Full-time – child can attend the program on all school days (approximately 20 days per month) - $250/month
Part-time – child can attend the program a max of 12 days/month - $160/month
Casual – child can attend the program a max of 5 days/month - $70/month
I do not require after school care

*If you require extra visits (beyond the 5 or 12 max days per month), additional care will be provided at a rate of $15/visit.

Do you have approval from another organization to cover the fees? If so, please provide us with their information:

Organization:

Contact Name:

Email Address:

Phone Number:

CHANGES TO CONTRACT AND CANCELLATION POLICY

By signing this agreement, you are committing to this service agreement for the 2023-2024 School Year. Please note, changes/cancellations to this agreement require written notice BEFORE the 1st day of the month affected. For example, if you would like to change/cancel for October, you must submit the Satellite Site Contract Amendment Form by September 30th (or earlier). Please contact the office to request a Contract Amendment Form or visit our website (www.bgcbattlefords.ca). BGC Battlefords also reserves the right to terminate this program by providing one month’s notice to families.

Changes to Contract and Cancellation Policy *

I have read and agree to abide by the Changes & Cancellation Policy.

Signature of Parent/Guardian: *

PARENT/GUARDIAN CODE OF CONDUCT

The purpose of the Parent/Guardian Code of Conduct is to provide a mutual understanding regarding conduct expectations. BGC Battlefords staff are committed to providing a caring and supportive environment for all families by acting with integrity and holding themselves to the highest standard of ethical conduct. We recognize the importance and value of a mutually supportive and respectful relationship between the staff and parents/guardians. Parents/guardians play an important role by supporting the efforts of the staff in maintaining a safe environment when they follow protocols.

BGCB prohibits the following behaviors:

• Abuse and harassment of any kind towards staff and volunteers will not be tolerated.

• Unpaid fees for services. Suitable arrangements must be mutually agreed upon.

• Unsatisfactory attempt to resolve an issue using the conflict resolution steps.

• A participating child/youth’s inappropriate behaviors which cause a risk to themself and other participants on a continual basis, even after supportive care plan meetings with Management.

• Parents/guardians that choose to post grievances and criticism publicly on social media that disparages the reputation of BGCB or its employees and have not sought direct communication with the Executive Director or Director of Programs for clarity and/or conflict resolution.

Anyone not respecting the above guidelines may be suspended from program registration and/or asked to leave BGCB premises and/or have services terminated. In less severe situations, where remediation is viable, a warning will be provided, either verbally or in writing.

If BGCB plans to terminate service, a phone call will be made to the family by either the Director of Programs or the Executive Director. Additionally, a detailed note regarding the termination will be placed in the Membership File.

Parent/Guardian Code of Conduct *

I have read and agree to the above Parent/Guardian Code of Conduct.

Signature of Parent/Guardian: *

PARTICIPANT CODE OF CONDUCT

This Participant Code of Conduct has been crafted by BGC Battlefords to ensure the safety and enjoyment of all participants at our programs. It balances the safety of participants, staff, and volunteers with respect for our participants and the desire to see everyone succeed while having fun. It is our expectation that all children and youth will follow these guidelines, as will our staff and volunteers.

Participant Code of Conduct

• Show respect for others:

• No running indoors

• Maintain a low volume indoors

• No name calling, profanity, or aggressive language

• No shoving, pushing, hitting, fighting, or any other aggressive physical contact

• Ensure you have the consent of other participants before touching them in any way (including hugs, patting, etc.)

• Be kind and polite

• Join in on the day’s activity/program

• Show respect for Club staff and volunteers:

• Always listen to staff

• Always get permission to leave the group before leaving (let them know if you need to use the washroom, get a drink, etc.)

• Show respect for the facility and equipment:

• Always get permission before going into another room

• Always get permission before taking out equipment or supplies

• Take part in the clean-up of toys, supplies, equipment, etc.

• Show respect for yourself:

• Ask questions

• Speak out when you have an idea

• Let staff know if you’re not having fun

Bullying and Harrasment

BGC Battlefords has a zero tolerance for bullying, and staff will act accordingly when they believe that this is taking place. Bullying and Harassment are defined as any inappropriate conduct, comment or behaviour that intimidates, demeans, humiliates or embarrasses a person, and that a reasonable person would know it unwelcome. It may be a single incident, or continue over time, typically between individuals with an imbalance of power.

Suspension

The following behaviours may result in the immediate suspension of a participant. Depending on the severity of the behaviour or repeat offences, the suspension may, at Club’s discretion, last a day, week, or the remainder of the program year.

• Derogatory comments regarding someone’s race, religion, sexual orientation, or gender identity.

• Endangering the health or safety of a participant and/or staff, members, and volunteers.

• Stealing or willfully damaging Club or personal property

• Leaving the program without permission

Other infractions of the Participant Code of Conduct may also, over time, lead to the suspension or dismissal of participants. Parents/guardians of children will be made aware of these infractions and asked to provide assistance in finding solutions before suspension or dismissal are considered.

Commitments

We commit to teaching these guidelines to all participants and to enforcing them fairly. We ask that parents help us by reinforcing these expectations with their children and by helping their children understand the importance of showing respect to others, the organization, and themselves.

Participant Code of Conduct *

I have read and agree to the above Participant Code of Conduct.

Signature of Parent/Guardian: *

MEMBERSHIP CONTRACT

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

• I understand that any violations of the above Codes of Conduct may result in services being terminated. *

• 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, BGCB, its staff, volunteers, and/or 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. *

Date / Time (am/pm):

Date

Time

Signature of Parent/Guardian: *

*If you would like a copy of this membership 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.