East Mountains Summer 2025 Registration

2025 Summer Program Membership Application

The Boys & Girls Clubs of Santa Fe/Las Vegas is proud to once again open register for our Summer Program in the East Mountains at Edgewood Middle School and Moriarty Middle School for ages 5 - 12. The program will run for eight weeks from June 9th - July 25th, 7:00 AM - 6:00 PM. Breakfast and lunch will be included daily.

This year registration will look a bit different. Due to funding issues, we will be offering the following two options:

1. ECECD Childcare Subsidy: We will be licensing our Sites for Childcare through New Mexico's Early Childhood Education and Care Department. If you are awarded a Childcare Contract for the Summer, there will be no charge to attend the Summer Program. Plese see this link for more information about Eligibility and how to apply: https://www.nmececd.org/wp-content/uploads/2024/05/ECECD-Child-Care-Assistance-Brochure-English-_-June-2024.pdf

If you select this option, we will e-mail you with further instructions on how to register for a Childcare Subsidy.

2. Program Fee: For those that do not qualify for ECECD, we will be charging a monthly fee of $400 for the first month and $300 for the second month, or $600 for the entire summer if you pay up front.
The Boys & Girls Club of Santa Fe/Las Vegas has an obligation to the community to provide a safe environment for our children and to stand by our motto by being "A Positive Place for Kids".

I acknowledge an awareness of the late pick-up policy and understand $5.00 will be charged for the first five (5) minutes after the pick-up time of 6:00 pm and $1.00 charged every minute thereafter. For the second late pick-up, the same fees apply and you must attend counseling with BGCSF/LV staff. If a third late pick-up occurs, the same fees apply and CYFD will be notified. If you are going to be late, you must speak to the Site Director to avoid late fees.
Parent Signature

Clear
Date

MonthDayYear
Date
It is mandatory that every member has a fully completed application. Be sure to fill out every applicable section of the membership application.
Site Selection
Registration Type
Contact Information
Name

Members First NameMiddle NameLast Name
Member Lives With
Home Phone No
Cell Phone No
Home Address

Address

Street Address Line 2

CityState

Postal Code
E-mail Address
Demographics
Gender
Date of Birth
Month/Day/Year
Age
Ethnicity
Parent/Guardian Information
Name

Fathers First NameFathers Last Name
Fathers Work Phone/Ext
Fathers Employer
Name

Mothers First NameMothers Last Name
Mothers Work Phone/Ext
Mothers Employer
Name

Guardians First NameGuardians Last Name
Guardians Work Phone/Ext
Guardians Employer
THE FOLLOWING MEDICAL/EMERGENCY INFORMATION IS REQUIRED:
Physician
Insurance Company
Insurance Policy Number
Physician Phone
(please initial)

BGC staff has my permission to transport my child in the case of an emergency.
Confidential

The following information is necessary for our records and the funding our Club receives. The answers you provide are completely confidential. Your cooperation in providing this information is appreciated.
Annual Income
MEMBERSHIP:

I have read the completed application and the Boys & Girls Clubs of Santa Fe/Las Vegas (BGCSF/LV) Member Handbook and understand the rules of the Club and request that my child/ren be admitted into membership. I have explained the rules to my child/ren and we agree that all rules of the Club will be followed.

SUPERVISION POLICY: I understand that once my child/ren is signed out of the program/premises, they are no longer under the supervision of the BGCSF/LV staff.

MEDIA CONSENT: I hereby give permission to BGCSF/LV to utilize photos or videos of my child in Club publicity. I consent to such uses and hereby waive all rights of compensation.

TECHNOLOGY: I understand that all BGCSF/LV members are expected to follow all rules and regulations for using the Internet and technology center, including mobile devices like e-readers and tablets, for any activity that involves technology. Rules and guidelines are posted at each site and in the Club computer lab. Failure to abide by the rules and guidelines may result in temporary or permanent loss of access to any technology at the Club.

ASSURANCE OF CONFIDENTIALITY: The information collected about your child will be kept private and locked in a secure area.

FEES: All Registration Fees are Non-Refundable.
Parent or Guardian Signature

Clear
Date

MonthDayYear
Date
BOYS & GIRLS CLUBS
AGE 18+ EMERGENCY/CHILD PICK-UP AUTHORIZATION FORM
Childs Name
* 4 Contacts/Pick-up persons required for valid application per guidelines

#1 Main Emergency/Pick-Up Person:
Name
Relationship to child
Home Phone
Cell Phone
Cell Phone
#2 Main Emergency/Pick-Up Person:
Name
Relationship to child
Home Phone
Work Phone
Cell Phone
Additional person who may pick up child:
Name
Relationship to child
Home Phone
Cell Phone
Cell Phone
Additional person who may pick up child:
Name
Relationship to child
Home Phone
Work Phone
Cell Phone
PLEASE COMPLETE THE FOLLOWING IF APPLICABLE. YOU WILL BE REQUIRED TO

PROVIDE A COPY OF OFFICIAL COURT-ISSUED PAPERWORK.

Person/s NOT AUTHORIZED to pick up child:
Name
Relationship to child
ParentGuardian Signature

Clear
Date

MonthDayYear
Date
Registration Fee
prevnext( X )
Summer Program Fee for Entire Summer
$600.00 Quantity

Summer Program Fee for One Month
$400.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Contact Information

Demographics

Parent/Guardian Information

Confidential

BOYS & GIRLS CLUBS

AGE 18+ EMERGENCY/CHILD PICK-UP AUTHORIZATION FORM