Discovery Club Summer ‘26 Registration

I’m new to Discovery ClubI’m new to Discovery Club and I have a childcare voucherMy child is currently enrolled in Discovery ClubMy child is currently enrolled in Discovery Club and I have a childcare voucher

Child's Information

Summer Camp 2026
First & Last Name*
Date of Birth*

MonthDayYear
Date
Grade in Fall 2026*
Age*
Date

MonthDayYear
Date
Address*
Primary Language*
Parent/Guardian Information
First & Last Name*
Relationship to Child*
Home Address*
Home Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Business/Work Name*
Business/Work Address*
Business/Work Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Hours at Work*
- First & Last Name
- Relationship to Child
- Home Address
- Home Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Cell Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Business/Work Name
- Business/Work Address
- Business/Work Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Hours at Work
- YesNo
- Per EEC guidelines, Discovery Club is required to have copies of any custody agreements, court or restraining orders on file to ensure the safety of your child and the program. If you selected "yes" to the question above, a staff member will reach out to you via email to obtain any relevant documents.

Child's Health & Identifying Information

Summer Camp 2026
YesNo
YesNo
Chronic health condition(s)*
If none, type N/A
Allergies*
If none, type N/A
If your child has any physical limitations, please list them here
Physician/Clinic Name*
Physician/Clinic Address*
Physician/Clinic Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Identifying Marks*
Scars, birthmarks, etc. If none, type N/A
Special Diet*
If none, type N/A
Eye Color*
Hair Color*
Height*
Weight*
Biological Sex*
This is your child's sex assigned at birth. If your child's gender identity is different than their biological sex, please contact us to let us know!
Ethnicity*
Physical & Immunization Records

Summer Camp 2026
Child's Current School *
School Address*
I certify that documentation of physical examination and immunizations in accordance with public school health requirements, and lead poisoning screening inaccordance with public health requirements are on file at my child's school.
Initial Here*
Educational Supports & Accommodations
Our summer camp program is designed to be active, social, and group-based. To ensure a positive experience for every child, we ask a few questions about your child’s school setting and support needs.

Understanding whether your child participates in general education classes, receives small group instruction, or has additional classroom supports helps us better prepare our staff, structure activities thoughtfully, and create an environment where your child can feel successful and included.

For children who receive additional supports during the school year, we require a brief meeting with a parent/guardian prior to the program start date. This allows us to learn more about your child’s strengths, strategies that work well, and any accommodations that may help them thrive in our program.

Please note: While we are committed to supporting a wide range of learners, our summer camp operates in a group setting and we are not able to provide dedicated 1:1 aides or individualized care. We will always be transparent if we feel that our program is not the right fit, and we value open communication in determining what will best support your child.
General Education classesParaprofessional support in General Education classesSmall group Special Education classesLow ratio staff to student (1:2 to 1:8)1:1 or 1:2 support

Emergency Contacts

Please list contacts in the order you'd like them to be contacted. By adding these contacts, you are giving permission for your child to be released to them.
Emergency Contact #1
First & Last Name*
Emergency Contact #1
Primary Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Emergency Contact #2
First & Last Name*
Primary Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Type a question*
Emergency Contact #3
First & Last Name*
Primary Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child*

Public Relations & Field Trip Consent
YesNo
YesNo

First Aid & Emergency Medical Care Consent

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 cannot 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.
Health Insurance Provider*
Subscriber of Policy*
Policy Number*

Transportation Plan & Transportation Authorization
Guardian drop offSchool bus drop off
Guardian pick upSchool bus pick up
Discovery Club does not provide bus transportation. The only circumstance in which a child may be dropped off or picked up at the program by a school bus is if the child is attending summer school at a Marlborough Public School. In this case, the school is responsible for arranging transportation to and from Discovery Club.

Please note that Discovery Club is not responsible for your child until they have been successfully dropped off at the program by the school-arranged transportation.
Authorized Pick-Up Contacts

I authorize the following individuals to pick up my child from the program. I understand that if someone not listed will be picking up my child, I must notify Discovery Club by phone or email prior to pickup. Discovery Club will not release a child to any unauthorized individual without explicit guardian consent.
First & Last Name*
If no one else is authorized, type "No one"
Primary Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child*
- First & Last Name
- Primary Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Child
- First & Last Name
- Primary Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Relationship to Child

Guardian Signature

By signing below, I acknowledge that I have reviewed and understand the Discovery Club Summer Program policies and procedures. I certify that the information provided in this registration form is accurate and complete to the best of my knowledge. I understand that failure to follow program policies may result in my child’s suspension or dismissal from the program.
Signature

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Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Thank you for registering for 2026 Discovery Club Summer Program held at the Kane Elementary School. All Guardian Summer Information will be emailed to registered families the 2 weeks before the first day of program.
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Discovery Club Summer 2026 Schedule Selection

TOTAL BALANCE

Child's Information

Parent/Guardian Information

Child's Health & Identifying Information

Physical & Immunization Records

Educational Supports & Accommodations

Emergency Contact #1

Emergency Contact #2

Emergency Contact #3

Public Relations & Field Trip Consent

First Aid & Emergency Medical Care Consent

Transportation Plan & Transportation Authorization

Authorized Pick-Up Contacts

Guardian Signature