Personal Info:
School Info:
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.)
Please list any medical/behavioral concerns for this child *
Family Setting:
Family Setting *
2 Parents in Household
Lives with Mother
Lives with Father
Lives with Grandparent(s)
Lives with Extended Family
Shared Custody
Lives with Foster Family
Other
Other
(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:
Sign up for Summer Weeks (Members $110.00-$130.00/child/week, Non-Members $145.00-$175.00/child/week)
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.)
Personal Info:
School Info:
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.)
Please list any medical/behavioral concerns for this child
Family Setting:
Family Setting
2 Parents in Household
Lives with Mother
Lives with Father
Lives with Grandparent(s)
Lives with Extended Family
Shared Custody
Lives with Foster Family
Other
Other
(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:
Sign up for Summer Weeks (Members $110.00-$130.00/child/week, Non-Members $145.00-$175.00/child/week)
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.)
Personal Info:
School Info:
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.)
Please list any medical/behavioral concerns for this child
Family Setting:
Family Setting
2 Parents in Household
Lives with Mother
Lives with Father
Lives with Grandparent(s)
Lives with Extended Family
Shared Custody
Lives with Foster Family
Other
Other
(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:
Sign up for Summer Weeks (Members $110.00-$130.00/child/week, Non-Members $145.00-$175.00/child/week)
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.)
(Tickets will be distributed to parents for resale on the first day of raffle ticket sales – parents will be notified of the ticket availability via e-mail, the club’s Facebook page and the club’s web site. Ticket sales commence in mid-September and the draw will be held in November. If you elect NOT to purchase the 1 book of 10 tickets you must complete a total of 25 hours of volunteer time by December 31 of the membership year. For each ADDITIONAL book of tickets you purchase you will be credited with 2 volunteer hours in the First Semester of the membership year.)
Number of Books
Number of Months
Fee/Book
Amount
No Westjet Raffle Tickets left
10
$100.00
$0.00
Parents will be notified of the ticket availability via e-mail, the club’s Facebook page and the club’s web site. Ticket sales commence in mid-February and the event will be held in March. If you elect NOT to purchase the 1 ticket you must complete a total of 25 hours of volunteer time by June 28th of the membership year. For each ADDITIONAL book of tickets you purchase you will be credited with 1 volunteer hour in the Second Semester of the membership year.)
Number of Tickets
Fee/Ticket
Amount
No Poker Tickets left
$65.00
$0.00
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.