BEC Application

BEC PROGRAMS APPLICATION
1209 Opal Street Kannapolis, NC 28083 704-938-8814 Office 704-938-8835 Fax becncprograms@gmail.com

BEC Programs

"Doing our Part to Profoundly Impact the Community"
BEC Programs Registration Form
CHILD:
First
Last Name
Birthdate

MonthDayYear
Date
Code Word
The code word should be something only parents, BEC and those are The on the list of names to pick up your child should know. Please do not give your child the CODE who parent can change the code word anytime you feel you need to change it to protect your child WORD. with a picture ID card
Sex
Age
Grade
Is your child potty trained?
1ST PARENT/GUARDIAN:
Name
Address
City
State
Home Phone Number
Please enter a valid phone number.
Authorized to Pick Up (If Different from Child):
Email
example@example.com
Cell
Best Contact
2nd Parent/Guardian
Name
Address
City
State
Home Phone Number
Authorized to Pick Up: (If Different from Child)
Email
example@example.com
Cell
Best Contact
EMERGENCY CONTACT:
Please list anyone allowed to pick-up your child. Identification by photo ID may be required at any time.
Name
Address
Phone Number
Please enter a valid phone number.
Second Phone#
Relationship to Child
Name
Address
Phone#
Second Phone#
Relationship to Child
AUTHORIZED PICK-UP:
Please list anyone allowed to pick-up your child. Identification by photo ID may be required at any time.
Name
Address
Phone#
Second Phone#
Relationship to Child
Name
Address
Phone#
Second Phone#
Relationship to Child
BEC PROGRAMS PUBLICITY RELEASE FORM
I hereby consent to have my child photographed/videotaped/recorded by Bethel Enrichment Center (BEC) Programs. I agree that BEC Programs may use my child's name, voice, or image and any quotes attributable to my child in any marketing materials associated with BEC Programs.

Ihereby waive all rights related to BEC Programs use of the above materials. I have hereby read and understand the above and hereby affix my signature indicating my agreement and certification that I am the parent of a child under eighteen years of age.
Print Child's Name
Parent Guardian Signature

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I, Name of Parent/Guardian Parent/guardian of Name of Child give permission to the BEC Programs, for my child to participate in the following activities:

Trips in the Van/Bus/Automobile (facility or parent-owned)
Field Trips away from the facility
I understand that the Facility will use the appropriate child restraint devises and abide by all the safety rules when transported in vehicles.
Parent/Guardian Signature
BEC Programs Health History Form
Allergies(type) List all food, medication, and other:
Medical Conditions (ear infections, seizures, diabetes, asthma, etc.)
List any Medications
Will Medications need to be administered by camp staff?

YesNo
Children will not be givn any medication, variation in diet, or any other remedy or treatment, nor can special medication procedures be carried out, except upon written order of a physician, or under written Instruction from a parent, guardian, or person having legal custody of the child. Medication must be carefully labeled with the child's name and in the original container. Medication will be kept beyond the reach of children and will be returned, when no longer needed, to the parent, guardian, or person having legal custody of the child.
Child Immunization Record

Cancelof
Authorization for Emergency Medical Care
As a parent or legal guardian of blanks , I hereby give consent for my child to participate in the BEC Before/After School and related activities on and off the campus of the Bethel Enrichment Center (BEC) Programs. Permission is hereby granted to the staff of the BEC Programs to precede with ANY needed care which may include the administering of first aid in the case of injury, obtaining of emergency health care, and arranging for the transportation of my child in need of emergency health care, with immediate notification of the custodial parent, guardian, or person having legal custody. If unsuccessfully, needed emergency treatment may ne given as necessary for the best interest of my child and a copy of this permission form will be furnished to the doctor in charge. I also grant permission for treating physician to release information to the staff and/or health related information needed to care for my child with physician, camp directors, teachers, and other healthcare providers throughout the BEC Programs session. I also understood that this agreement covers only those situations which are in the best judgment of the BEC Programs Staff. The health history is correct to the best of my knowledge, and the child herein described has permission to engage in all prescribed activities, except as noted by a physician or myself.
Parent Signature:

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Discipline and Behavior Mangement Policy
Praise and Positive reinforcement are affective methods of the behavior management of children. When children recieve positive, non-violent, and understanding interactions from adults and others, they develop food self-concepts, problem solving abilities, and self-values, this facility will practice the following discipline and behavior management policy:
We:
- DO praise, reward, and encourage the children
- DO reason with and set limits for children
- DO model appropriate behavior for the children
- DO modify the classroom enviroment to attempt to prevent problems before they occur
- DO listen to the children
- DO provide the children with natural and logical consequences of thier behaviors
- DO treat the children as people and respect their needs, desires, and feelings
- DO explain things to children on their levels
- DO use short supervised periods of "time-out"
- DO stay consistent in our behavior management program
We:
- DO NOT spank, shake, bite, pinch, push, pull, slap, or otherwise physically punish the children
- DO NOT make fun of, yell at, threaten, make sarcastic remarks about, use profanity, or otherwise verbally abuse the children
- DO NOT shame or punish the children when bathroom accidents occur
- DO NOT deny food or rest as punishment
- DO NOT relate discipline to eating, resting, or sleeping
- DO NOT leave the children alone, unattended, or without supervision
- DO NOT place the children in locked rooms, closets, or boxes as punishment
- DO NOT allow discipline of children by children
- DO NOT criticize, make fun of, or otherwise belittle children's parents, families, or ethnic groups.
I, the undersigned parent or guardian of Child's Full Name, do hereby state that I have read the facility's Discipline and Behavior Management Policy.
Parent Signature

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BEC PROGRAMS APPLICATION

BEC Programs Registration Form

CHILD:

1ST PARENT/GUARDIAN:

2nd Parent/Guardian

EMERGENCY CONTACT:

AUTHORIZED PICK-UP:

BEC PROGRAMS PUBLICITY RELEASE FORM

BEC Programs Health History Form

Authorization for Emergency Medical Care

Discipline and Behavior Mangement Policy