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Register for the After School Program or Summer Camps

Does your child have any additional needs and challenges that might impact their ability to attend the Club safely and securely? These situations can include (but are not limited to) the presence of significant behavioral issues, complex medical conditions, physical/mental emotional health and wellness concerns). If you child has any of these concerns, please contact the Club directly to discuss next steps PRIOR to completing the registration process.

Primary Parent/Guardian

Personal Info:







Phone Numbers:





Email Addresses:




The Home e-mail addresses noted will be used to communicate all Boys and Girls Club of Leduc information related to club fund-raising, volunteer and child-focused activities to parents.


Work Info:




Second Parent/Guardian

Personal Info:







Phone Numbers:





Email Addresses:




Work Info:




Non-Parent Emergency Contacts 2 People Required (ideally within the City of Leduc, or close proximity)

Contact 1:






Contact 2:






Contact 3:







Child Information Child 1

Personal Info:






School Info:



Bussing is full

Medical Info:

(The Boys and Girls Club of Leduc requires that all medical and behavioural information be accurate to for your child’s safety. All information provided will be protected by law and only available to staff to the Boys and Girls Club of Leduc. Please note that while we will make every effort to work with families to find solutions, we may not have the capacity to accommodate complex medical or behavioural conditions.)




Family Setting:





(If there are any court orders in place that impact custody, care and/or access with the children, please provide a copy to us for our files. Otherwise, the assumption will be made that BOTH parents have equal rights, access and decision making in regards to the children, and act accordingly. Verbal instructions will NOT be followed without proper documentation to back up the request.)

2023 - 2024 Summer Programs Registration:


2023 - 2024 After School Program is full


(Membership entitles child to attend the 2023 - 2024 After School Program and to reduced Summer Fees.)


Select Session Cost
Class is full Week 1 - July 4th to 7th - Sports Week - Short Week, 2023 $0.00
Class is full Week 2 - July 10th to 14th - Nature Week, 2023 $0.00
Class is full Week 3 - July 17th to 21st - Adventure Week, 2023 $0.00
Class is full Week 4 - July 24th to 28th - Discovery Week , 2023 $0.00
Class is full Week 5 - July 31 - August 4th - Animal Week , 2023 $0.00
Class is full Week 6 - August 8th to 11th - Plaines, Trains & Automobiles - Short Week, 2023 $0.00
Class is full Week 7 - August 14th to 18th - Water Week, 2023 $0.00
Class is full Week 8 - August 21 to 25th - Dinosaur week, 2023 $0.00
Child's Subtotal $0.00

(Summer Programming consists of a variety of activities for children aged 6 to 12 years. You may drop your child off at the club at 8:00 am and you must pick them up by 5:00 pm each day they attend. Programming is sold by the week only.)

Child Information Child 2



Personal Info:






School Info:



Bussing is full

Medical Info:

(The Boys and Girls Club of Leduc requires that all medical and behavioural information be accurate to for your child’s safety. All information provided will be protected by law and only available to staff to the Boys and Girls Club of Leduc. Please note that while we will make every effort to work with families to find solutions, we may not have the capacity to accommodate complex medical or behavioural conditions.)




Family Setting:





(If there are any court orders in place that impact custody, care and/or access with the children, please provide a copy to us for our files. Otherwise, the assumption will be made that BOTH parents have equal rights, access and decision making in regards to the children, and act accordingly. Verbal instructions will NOT be followed without proper documentation to back up the request.)

2023 - 2024 Summer Programs Registration:



2023 - 2024 After School Program is full


(Membership entitles child to attend the 2023 - 2024 After School Program and to reduced Summer Fees.)


Select Session Cost
Class is full Week 1 - July 4th to 7th - Sports Week - Short Week, 2023 $0.00
Class is full Week 2 - July 10th to 14th - Nature Week, 2023 $0.00
Class is full Week 3 - July 17th to 21st - Adventure Week, 2023 $0.00
Class is full Week 4 - July 24th to 28th - Discovery Week , 2023 $0.00
Class is full Week 5 - July 31 - August 4th - Animal Week , 2023 $0.00
Class is full Week 6 - August 8th to 11th - Plaines, Trains & Automobiles - Short Week, 2023 $0.00
Class is full Week 7 - August 14th to 18th - Water Week, 2023 $0.00
Class is full Week 8 - August 21 to 25th - Dinosaur week, 2023 $0.00
Child's Subtotal $0.00

(Summer Programming consists of a variety of activities for children aged 6 to 12 years. You may drop your child off at the club at 8:00 am and you must pick them up by 5:00 pm each day they attend. Programming is sold by the week only.)

Child Information Child 3



Personal Info:






School Info:



Bussing is full

Medical Info:

(The Boys and Girls Club of Leduc requires that all medical and behavioural information be accurate to for your child’s safety. All information provided will be protected by law and only available to staff to the Boys and Girls Club of Leduc. Please note that while we will make every effort to work with families to find solutions, we may not have the capacity to accommodate complex medical or behavioural conditions.)




Family Setting:





(If there are any court orders in place that impact custody, care and/or access with the children, please provide a copy to us for our files. Otherwise, the assumption will be made that BOTH parents have equal rights, access and decision making in regards to the children, and act accordingly. Verbal instructions will NOT be followed without proper documentation to back up the request.)

2023 - 2024 Summer Programs Registration:



2023 - 2024 After School Program is full


(Membership entitles child to attend the 2023 - 2024 After School Program and to reduced Summer Fees.)


Select Session Cost
Class is full Week 1 - July 4th to 7th - Sports Week - Short Week, 2023 $0.00
Class is full Week 2 - July 10th to 14th - Nature Week, 2023 $0.00
Class is full Week 3 - July 17th to 21st - Adventure Week, 2023 $0.00
Class is full Week 4 - July 24th to 28th - Discovery Week , 2023 $0.00
Class is full Week 5 - July 31 - August 4th - Animal Week , 2023 $0.00
Class is full Week 6 - August 8th to 11th - Plaines, Trains & Automobiles - Short Week, 2023 $0.00
Class is full Week 7 - August 14th to 18th - Water Week, 2023 $0.00
Class is full Week 8 - August 21 to 25th - Dinosaur week, 2023 $0.00
Child's Subtotal $0.00

(Summer Programming consists of a variety of activities for children aged 6 to 12 years. You may drop your child off at the club at 8:00 am and you must pick them up by 5:00 pm each day they attend. Programming is sold by the week only.)



Monthly PAD Bussing Form




Payment for:

Bussing Fees: x $40.00/month = $ - Check the Monthly option in the Frequency section and enter the total monthly amount in the Amount Field below and specify Start and End Dates for monthly bussing payments.

In the event of a returned payment for NSF or other reasons, we will attempt to pull the payment again fifteen (15) days after the first attempt date, along with a $25.00 fee for the returned payment. If the second attempt to pull the fees is unsuccessful, payment arrangements will need to be made within two (2) weeks or access to bussing or the club may be suspended until payment is made in full.

Bank Information




 



 



Volunteer Deposits PAD Agreement







I/We understand that the bank account provided below (and on the attached voided cheque or CAFT document provided by the bank) will be the bank account from which all deposits will be deducted if it is necessary for the BGC Leduc to redeem the following deposits. If all volunteer commitments are met and my child/children are never picked after BGC closure times I understand that these deposits will not be redeemed. The club will provide me with an electronic version of the Sales Receipt for each deposit redemption that occurs.

Bank Information




 

Volunteer Deposits and volunteering commitments:

If the volunteer commitment is not completed per session the following deposit will be redeemed via automatic withdrawal from the bank account noted above 1 week after the session end date.

# of Children Session 1: Sept to Dec Volunteer Deposit Session 2: Jan to May Volunteer Deposit
Session 1:
10 Hours volunteering
$400.00 Session 2:
10 Hours volunteering
$400.00
Session 1:
20 Hours volunteering
$800.00 Session 2:
20 Hours volunteering
$800.00
Session 1:
30 Hours volunteering
$1200.00 Session 2:
30 Hours volunteering
$1200.00



Summary of Payments

(Membership entitles child to attend the 2023 - 2024 After School Program and to reduced Summer Fees. Membership fees are NOT pro-rated based on usage. * Payment plans available when registering in person at the club.)


Number of Children Amount
0 $0.00


Number of Children Number of Months Fee/Child/Year Amount
0 10 $400.00 $0.00

Summer Programs are sold by the week only and are NOT pro-rated based on usage. *Payment plans available.


Number of Children Number of Weeks Amount
0 0 $0.00


Number of Children Number of Weeks Amount
0 0 $0.00


FinalAmount
$0.00

Terms & agreements





Confidentiality: Confidential information requested is for club records and for the funding the Boys and Girls Club of Leduc receives. The answers you provide will be kept completely confidential. Your cooperation in providing this information is both appreciated and necessary. The four people you list below are approved as Emergency Contacts for your child/children and as Individuals who may pick up your child/children from the Boys & Girls Club of Leduc at the end of a program session.