2019-2020 Holy Family 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

Parent/Guardian #1 Information

Parent/Guardian #2 Information

Contract Agreement

*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.

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.

IMPORTANT

Please note EVERYONE picking up children will be asked for your release password or government issued photo ID.

Custody & Related Court Orders

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.

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.

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.

Media Consent & Release