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Take it EASY
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FORMS
2021 Membership Form
2020-2021 Raise the Grade Registration
2020-2021 Project Backpack Registration Form
2021 Volunteer Application Form
2021 Summer Adventure Day Camps Registration Form
2021 Summer Adventure Day Camps Contract Amendment Form
Newsletter Sign Up
ANNUAL EVENTS
Gala
Pink Shirt Day
Race For Kids
Raise for Kids
CONTACT US
Menu
HOME
ABOUT US
Annual Reports
2016 Annual Report
2017 Annual Report
2018 Annual Report
COVID-19 INFORMATION
Work With Us
Volunteer With Us
PROGRAMS
Main Site Programs
After School and Evening Programs
Supper Program
Innovation Credit Union Saturday Program
Husky Energy Youth Program
Non-School Days Program
Satellite Site Programs
Bready Before-and-After School Program
EMBM Before-and-After School Program
Holy Family After School Program
Summer Programs
Summer Adventure Day Camps
Summer Parks Drop-in Programs
Special Programs
2B Boys Program
Family Wellness Program
Hip Hop Dance Program
Hockey Program
Kid Food Nation
Lacrosse Program
Music Program
Project Backpack Program
Raise the Grade
Soccer Program
Take it EASY
Yoga Program
DONORS
Major Donors
Supporters
Building Donors
FORMS
2021 Membership Form
2020-2021 Raise the Grade Registration
2020-2021 Project Backpack Registration Form
2021 Volunteer Application Form
2021 Summer Adventure Day Camps Registration Form
2021 Summer Adventure Day Camps Contract Amendment Form
Newsletter Sign Up
ANNUAL EVENTS
Gala
Pink Shirt Day
Race For Kids
Raise for Kids
CONTACT US
2019-2020 Bready School Membership Form
Please enable JavaScript in your browser to complete this form.
2019-2020 Bready Before and After-School Membership Form
Please fill out one form for each child attending. By signing this agreement, you are committing to this service agreement for the 2019-2020 School Year. Families are required to provide ONE MONTH'S NOTICE for any changes to this agreement. Boys & Girls Clubs of The Battlefords reserves the right to terminate this program by also providing one month's notice to families.
Member Information
Member's Name
*
First
Last
Address
*
Address Line 1
City
State / Province / Region
Birthdate (month/date/year)
*
Gender
*
Select One
Girl
Boy
Other
School
*
Ethnic Background (Please select those that apply):
First Nations / Metis
New Canadian
Francophone
Person with Disability
Health Card Number
*
Siblings who are members:
Parent/Guardian #1 Information
Name
*
First
Last
Relation to Member
*
Phone Number
*
Email
*
Parent/Guardian #2 Information
Name
First
Last
Relation to Member
Phone Number
Email
Contract Agreement
Before-School Care (7:15am-8:30am)
*
Full-time: child will attend a max of 20 days/month: $100/month
Part-time: child will attend a max of 12 days/month: $60/month
Casual: child will attend a max of 5 days/month: $25/month
No Before-School care required.
After-School Care (3:25pm-5:30pm, Open Early on Early Dismissal Day)
*
Full-time: child will attend 4-5 days/week with a max of 20 days/month: $200/month
Part-time: child will attend 2-3 days/week with a max of 12 days/month: $120/month
Casual: child will attend a max of 5 days/month: $50/month
Early Dismissal Day ONLY: child can ONLY attend Early Dismissal Day: $15/day
No After-School care required.
Month that Service Starts
*
Select Month Here
January
February
March
April
May
June
September
October
November
December
*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. Invoices will be generated the 1st of every month for the next month’s services.
*In addition to accepting payments at the office, we are encouraging the use of e-transfers to ensure payments are received on time. E-transfers can be sent to
ac.bcgb@stnemyap
.
*For Part-Time and Casual Agreements:
- You must pre-register your child for this program by noon on the day requiring service;
- After-School Care: should you require additional visits outside the allotted amount in your chosen agreement, there will a rate of $12/day charged- this fee will be added onto the following month’s invoice.
- Before-School Care: should you require additional visits outside the allotted amount in your chosen agreement, there will a rate of $7/day charged- this fee will be added onto the following month’s invoice.
*An exception to the Full-Time Agreement rate will be made for the months in which Christmas Break, Winter Break and Easter Break occur.
Changes to Contract and Cancellation Policy
By signing this agreement, you are committing to this service agreement for the 2019-2020 School Year. Families are required to provide ONE MONTH'S NOTICE for any changes to this agreement. Boys & Girls Clubs of The Battlefords reserves the right to terminate this program by also providing one month's notice to families.
Medical Information
Does your child have any special need in the following areas? If yes, please explain further and indicated medications they are taking and diagnoses when applicable.
Physical
Learning/Behavioural
Medical/Allergies
Other (Any additional information which may assist your child in positively participating in our programs)
Emergency Contacts
These will be the people who are allowed to pick up your child or who will be called if a Parent/Guardian cannot be reached in an emergency. These contacts MUST be different than Parents/Guardians.
I (parent/guardian) give permission to the following individuals to act as parents designates to pick up my child(ren) from the Boys & Girls Clubs of The Battlefords After-School program. I have informed these individuals that they must present government issued photo ID or they must present a password each time they come to pick up my children. I understand that in case of an emergency, I will be the first one called. However, I also give my permission to the Boys & Girls Clubs of The Battlefords to contact the following individuals AFTER contact has failed with the parents designated on the front page of this registration form.
Emergency Contact #1
*
First
Last
Phone
*
Address
*
Address Line 1
City
State / Province / Region
Emergency Contact #2
*
First
Last
Phone
*
Address
*
Address Line 1
City
State / Province / Region
IMPORTANT
Please note EVERYONE picking up children will be asked for your release password or government issued photo ID.
Release Word
*
Custody & Related Court Orders
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 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 files, Boys & Girls Clubs of The Battlefords cannot deny access to the non-enrolling parent. If the non-enrolling parent is not listed as authorized pick-up list, but is able to produce government issued photo ID proving that they are the birth parent of the child, Boys & Girls Clubs of The Battlefords cannot legally deny access without legal documentation (custody or court order) stating otherwise.
Please list anyone WHO IS NOT ALLOWED to pick up your child:
I have provided Boys & Girls Clubs of The Battlefords with legal documentation (custody or court order).
Signature
Clear Signature
Date (month/day/year)
Membership Contract
I would like to become a member of Boys & Girls Clubs of The Battlefords and enjoy the privileges a member has. I agree to respect the Boys & Girls Clubs of The Battlefords staff, volunteers, and the rights of other members. I UNDERSTAND THAT BOYS & GIRLS CLUBS OF THE BATTLEFORDS IS A SAFE PLACE FOR ALL MEMBERS, AND IF I ACT IN A WAY THAT MAKES SOMEONE FEEL UNSAFE, I WILL BE ASKED TO LEAVE. I will abide by the rules set by the staff of Boys & Girls Clubs of The Battlefords. I also understand that if I do not abide by these rules, I may lose my privileges as a result and will not receive a refund of membership fees.
This membersthip is valid from September 1st, 2019 to June 30th, 2020. Membership Fee is $5.00 per child.
Member's Name
*
First
Last
Date (month/day/year)
I, the parent/guardian of the above individual, understand that my child is being asked to abide by the rules of the club. Should my child not abide by these rules, I agree to work with the staff of Boys & Girls Clubs of The Battlefords to help resolve the situation. I understand that Boys & Girls Clubs of The Battlefords staff and volunteers will be supervising club activities and programs during the club 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 my child may leave the premises of Boys & Girls Clubs of The Battlefords at his/her own will, and that I will make every effort to communicate with my child when he/she is to leave Boys & Girls Clubs of The Battlefords. I understand that should my child not be picked up prior to the closing hours of Boys & Girls Clubs of The Battlefords, the staff may be in contact with authorities such as the Battlefords RCMP and/or Social Services. I agree that under no circumstances are the staff members, volunteers or board members responsible for lost or stolen belongings. I further understand that my son/daughter has my permission to attend programs offered through Boys & Girls Clubs of The Battlefords, 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 son/daughter by Boys & Girls Clubs of The Battlefords, I waive my legal right against the Boys & Girls Clubs of The Battlefords, its staff or 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, and ambulance or other expenses.
Parent/Guardian's Name
*
First
Last
Date (month/day/year)
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 club activities for the purpose of advertisement and promotional campaigns in the future.
*
Yes, I agree.
No, I do not agree.
Signature
*
Clear Signature
Name
Submit