2021 Membership Form

MEMBER INFORMATION

PARENT/GUARDIAN INFORMATION

Parent/Guardian #1 Information

Parent/Guardian #2 Information

EMERGENCY CONTACTS

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

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.

CUSTODY AND/OR COURT ORDER

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 file, Boys & Girls Clubs of The Battlefords cannot deny access to the non-enrolling parent.

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 BGCb main site, Summer 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 include the child's full name in the memo section. BGCB 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.

MEDIA CONSENT & RELEASE

MEMBERSHIP CONTRACT

Parents/Guardians: Please review these guidelines/rules with your child.

If you want to become a member of Boys & Girls Clubs of The Battlefords (BGCB) and enjoy the privileges a member has you have to respect the staff, volunteers, and the other members. YOU MUST UNDERSTAND THAT BGCB IS A SAFE PLACE FOR ALL MEMBERS, AND IF YOU ACT IN A WAY THAT MAKES SOMEONE FEEL UNSAFE, 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 as a result and may not be able to return to BGCB in the future.

Parents/Guardians please read and agree to, by initialing beside, the following statements:

This membership is valid from September 1st, 2020 to December 31st, 2021. Membership Fee is $5.00 per child. Membership Fee is non-refundable.