1-306-445-0002
ac.bcgb@ofni

Donate Facebook-f Instagram Linkedin

HOME
ABOUT US
PARENT/GUARDIAN HANDBOOK
PROGRAMS
DONORS
FORMS
ANNUAL EVENTS
CONTACT US
DONATE

Menu

HOME
ABOUT US
PARENT/GUARDIAN HANDBOOK
PROGRAMS
DONORS
FORMS
ANNUAL EVENTS
CONTACT US
DONATE

2025 Membership Form

2025 membership form

2025 Membership Form

MEMBER INFORMATION

Child's Full Name: *

First

Middle

Last

Child's Birthday: *

Mailing Address: *

Address Line 1

City

State / Province / Region

Postal Code

Physical Address (if different):

Address Line 1

City

State / Province / Region

Gender: *

Boy
Girl
Transgender
Non-binary
2 Spirit
Choose not to answer

School: *

Grade: *

Siblings who are members:

Is this child in Foster Care?

Yes
No

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.

First Nations
Métis
Black
Person of Colour
New Canadian

Country of Origin:

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1 Information

Parent/Guardian #1 Name: *

First

Last

Relation to Member: *

Primary Phone Number: *

Alternate Phone Number:

Email Address: *

Employer:

Parent/Guardian #2 Information

Parent/Guardian #2 Name:

First

Last

Relation to Member:

Primary Phone Number:

Alternate Phone Number:

Email Address:

Employer:

EMERGENCY CONTACT INFORMATION

*Will be contacted only if we're NOT able to reach the parents/guardians listed above*

Emergency Contact #1 Name: (OTHER THAN the parents/guardians listed above. Ex: Family Friend, Co-worker, Neighbour, etc.) *

First

Last

Relation to Member: *

Primary Phone Number: *

City of Residence *

Emergency Contact #2 Name: (OTHER THAN the parents/guardians listed above. Ex: Family Friend, Co-worker, Neighbour, etc.) *

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.

Allergies: *

Medical Condition(s): *

Learning/Behavioral Needs: *

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

Yes
No

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 through our website (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: *

PARENT/GUARDIAN HANDBOOK

I acknowledge that I will/have read and adhere to the information provided in the Parent/Guardian Handbook.

View Parent/Guardian Handbook Here

Please view our Parent/Guardian Handbook here. Paper copies will also be available at our office.

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 do not agree.

Signature of Parent/Guardian:

MEMBERSHIP CONTRACT

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

• I understand that any violations of the Parent/Guardian and/or Participant Codes of Conduct may result in services being terminated. *

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

• 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: *
Date
Time

Signature of Parent/Guardian: *

*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, 2025 to December 31st, 2025. 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.

Website

© 2025 BGC Battlefords. All Rights Reserved.

Donate Facebook-f Instagram Linkedin Long-arrow-alt-up