Select days OR weeks you are registering for.
If you would like every day during the week please select the ALL WEEK option.
Child's Additional Information
If you answer yes to any of the following questions, please provide the Boys & Girls Clubs offices a copy of the proper documentation.
/ certify that documentation of physical examination and immunizations in accordance with public school health requirements, and lead poisoning
screening in accordance with public health requirements are on file at my child's school.
I authorize Discovery Club/BGCMW Staff who are trained in the basics of First Aid / CPR to give my child First Aid / CPR when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I can not be reached, I hereby authorize the program to transport my child to the nearest medical care facility, and to secure necessary medical treatment for my child.
I give permission for my child to be released from the program at the end of the day as stated above and/or give my permission to the above referenced people to receive my child at the end of the day.
This PERMISSION is valid for the current school year or summer camp.
ANY OTHER TRANSPORTATION REQUESTS MUST BE MADE IN WRITING.
This Form will be maintained in your child's file.
One time permissions will be with the daily attendance record or sent to your child's file.
*** If NO ONE is authorized, please indicate by writing "NO ONE" above.
Completes "Consent for Child to Leave the School Age Child Care Program" form per CMR 7.04(7a)8