2025-2026 Kids Zone and Teen Zone Registration Package

Kids Zone and Teen Zone Registration Package 2025-2026
ZONE REGISTRATION & CONTACTS
PARENT/GUARDIAN EMAIL ADDRESS*
example@example.com
START DATE

MonthDayYear
Date
SITE
PARTICIPANT FIRST AND LAST NAME*
PARTICIPANT DATE OF BIRTH*

MonthDayYear
Date
PARTICIPANT ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PARENT/GUARDIAN FIRST AND LAST NAME*
PARENT/GUARDIAN PHONE NUMBER 1*
Format: (000) 000-0000.
PARENT/GUARDIAN PHONE NUMBER 2*
Format: (000) 000-0000.
PARENT/GUARDIAN FIRST AND LAST NAME*
PARENT/GUARDIAN PHONE NUMBER 1*
Format: (000) 000-0000.
PARENT/GUARDIAN PHONE NUMBER 2 *
Format: (000) 000-0000.
PERMISSION & WAIVERS

I GIVE THE PARTICIPANT, AS NAMED ABOVE, PERMISSION TO PARTICIPATE IN THE FOLLOWING (INITIAL):
ANY TRANSPORTATION NECESSARY, WHETHER FOR MEDICAL TREATMENT OR CLUB USE*
INITAL
LEAVE THE CLUB WITH STAFF SUPERVISION
INITAL
ATTEND ANY FIELD TRIPS PLANNED BY THE CLUB
INITAL
UTILIZE THE CLUB POOL WHEN SCHEDULING ALLOWS
INITAL
ANY MEDICAL TREATMENT REQUIRED*
INITAL
YESNO
YESNO
YESNO
YOUR SIGNATURE BELOW INDICATES YOU HAVE FULLY READ, UNDERSTOOD AND COMPLETED THE REGISTRATION FORM AND AGREE TO ALL PERMISSIONS AND WAIVERS CONTAINED HEREIN.
SIGNATURE*

Clear
DATE*

MonthDayYear
Date
ZONE REGISTRATION & CONTACTS
KIDS ZONE (6-12 YEARS OLD)TEEN ZONE (13 + YEARS OLD)
NIAGARA FALLS CLUBST. CATHARINES CLUBFORT ERIE CLUB - EJ FREELAND CENTRE
ALLOWABLE PICK UPS AND EMERGENCY CONTACTS (other than guardians; will call guardians listed in Part 1 first in case of emergency)

IN APPROPRIATE CALL ORDER, ID REQUIRED FOR PICK UPS

ALLOWABLE PICK UPS AND EMERGENCY CONTACTS

Rows	NAME	RELATION	PHONE
1
2
3
4

SAFE ARRIVAL/SAFE RELASE & PARENT HANDBOOK

PLEASE INITIAL ALL THAT APPLY:
I AUTHORIZE MY CHILD TO PARTICIPATE IN THE BGC NIAGARA ZONE PROGRAM*
INITAL
I ACKNOWLEDGE THAT A GUARDIAN MUST BE PRESENT TO SIGN MY CHILD IN & OUT OF KIDS ZONE PROGRAMS*
INITAL
TEEN ZONE ONLY: I AUTHORIZE STAFF TO RELEASE MY CHILD FROM THE PROGRAM UNSUPERVISED
INITAL
I AUTHORIZE MY CHILD TO BE RELEASE TO THE NAMES PROVIDED UNDER ALLOWABLE PICK UPS*
INITAL
AFTER READING THE ZONES PROGRAM PARENT HANDBOOK, PLEASE INTIAL BELOW:
I HAVE PROVIDED THE BGC NIAGARA WITH THE MOST RECENT INFORMATION WITH RESPECTS TO MY CHILD INCLUDING EMERGENCY CONTRACTS AND SPECIAL REQUIREMENTS.*
INITAL
I AGREE TO KEEP MY CHILD HOME OR MAKE OTHER ARRANGEMENTS IF THEY ARE NOT WELL ENOUGH TO PARTICIPATE IN DAILY ACTIVITIES AND AM PREPARED TO PICK MY CHILD UP IF ILL WITHIN 45 MINUTES OF CLUB CONTACT*
INITAL
I WILL CALL THE BGC NIAGARA CLUB UNIT IF MY CHILD WILL BE ABSENT (IF APPLICABLE)*
INITAL
I ACKNOWLEDGE CLUB HOURS OF OPERATION AND WILL ADHERE TO PRACTICES IN PLACE AND FEES ATTACHED IN THE EVENT OF LATE PICK UPS AFTER PROGRAMMING ENDS*
INITAL
I HAVE READ THE PARENT HANDBOOK AND UNDERSTAND THE POLICIES AND PROCEDURES AS IT PERTAINS TO MY CHILD*
INITAL
YOUR SIGNATURE BELOW INDICATES YOU HAVE FULLY READ, UNDERSTOOD AND COMPLETED THE REGISTRATION FORM AND AGREE TO ALL PERMISSIONS AND WAIVERS CONTAINED HEREIN.
SIGNATURE*

Clear
DATE*

MonthDayYear
Date
SPECIAL REQUIREMENTS

When providing additional information about the supports your child requires, you may include behavioral strategies and individualized support plans from schools or childcare centers. We encourage open communication with parents as your insights are invaluable in understanding your child's unique needs. BGC Niagara provides programming at a 1 staff to 15 school age children ratio. At this time we cannot guarantee additional 1:1 supports. Please note that any information shared will be treated confidentially and will only be used to enhance the support provided. Collaborating closely will help us create a more effective and tailored approach to your child's development. BGC Niagara will review any special requirements and may require a phone or in person meeting to discuss your child’s needs while in care. Thank you for your partnership in this important process.
PARTICIPANT GENDER*
PARTICIPANT AGE*
PARTICIPANT HEALTH CARD NUMBER*
SPECIAL REQUIREMENTS

THIS SECTION WILL INFORM THE BGC NIAGARA STAFF OF ANY SPECIAL NEEDS THE PARTICIPANT HAS TO ENSURE A FULLY INTEGRATED SETTING AND OPPORTUNITIES FOR THE PARTICIPANT. IF THE PARTICIPANT HAS A DISABILITY OR REQUIRES MEDICATION FOR A SPECIAL NEED, PLEASE INDICATE BELOW. IF THE NEEDS OF THE PARTICIPANT REQUIRES ONE ON ONE SUPPORTS THE PARENT/GUARDIAN MUST MEET WITH THE SUPERVISOR TO DISCUSS SUPPORTS PRIOR TO COMMENCING SERVICES.
YESNO
IF YES, PLEASE SPECIFY*
IF NO, PLEASE ENTER N.A
PRESENTLYPREVIOUSLYNO
IF PRESENTLY WHAT MEDICATIONS*
IF NO, PLEASE ENTER N.A
WHEN*
IF NO, PLEASE ENTER N.A
HOW MUCH*
IF NO, PLEASE ENTER N.A
REASON*
IF NO, PLEASE ENTER N.A
YESNO
IF SO FROM WHAT AGENCY*
IF NO, PLEASE ENTER N.A
YESNO
IF SO FROM WHAT AGENCY*
IF NO, PLEASE ENTER N.A
YESNO
YESNO
IF SO WHAT ARE THEY AND WHAT IS THE LEVEL OF SEVERITY*
ADDITIONAL SUPPORT - PLEASE INDICATE THE LEVEL OF SUPPRT NEEDED IN THE FOLLOWING AREAS:
DRESSING
TOILETING
MOBILITY
COMMUNICATION
FEEDING OR FOOD/DIETARY RESTRICTIONS
BEHAVIOUR
MEDICATION DESCRIPTION

ANY MEDICATION DISTRIBUTED TO A PARTICIPANT BY A CLUB STAFF MUST BE CONTAINED IN THE ORIGINAL PRESCRIPTION BOTTLE FROM THE PHARMACY. ANY CHANGES TO THE ORIGINAL PRESCRIPTION MUST BE AUTHORIZED BY THE PHYSICIAN AND CHANGED AT THE PHARMACY.

MEDICATION DESCRIPTION*

Rows	NAME OF MEDICATION	DOSAGE (NOTE MG)	TIME TAKEN	DURATION
1
2
3
4

YOUR SIGNATURE BELOW INDICATES YOU HAVE FULLY READ, UNDERSTOOD AND COMPLETED THE SPECIAL REQUIREMENTS FORM AND AGREE TO ALL TERMS AND CONDITIONS CONTAINED HEREIN. I HEREBY AUTHORIZE THE STAFF OF THE BGC NIAGARA TO ADMINISTER THE MEDICATION AS INDICATED ON THIS FORM. I UNDERSTAND THAT ALL MEDICATIONS MUST BE CONTAINED IN THE ORIGINAL PRESCRIPTION BOTTLE AND CAN ONLY BE CHANGED BY THE PARTICIPANT'S PHYSICIAN OR PHARMACY. I AGREE TO NOT HOLD RESPONSIBLE ANY MEMBER OF THE CLUB STAFF FOR ANY ADVERSE EFFECTS THE MEDICATION MAY HAVE ON THE PARTICIPANT. IF THE ABOVE HAS NOT BEEN COM- PLETED, I ACKNOWELDGE THAT THE PARTICIPANT IS NOT TAKING ANY MEDICATION FOR THE DURATION OF THEIR TIME WITH THE BOYS AND GIRLS CLUB OF NIAGARA.
Signature*

Clear
Date*

MonthDayYear
Date
PARENT HANDBOOK
FINANCIAL AGREEMENT AND ACKNOWLEDGEMENT OF RULES AND REGULATIONS
After reading the 2025-2026 Zone Parent Handbook, please sign below. Your signature below indicates that you have fully read and understood the 2025-2026 Zone Parent Handbook and agree to all terms and conditions contained herein. Initial:
I have provided the BGC Niagara with the most recent information with respect to my child including emergency contacts and special requirements.*
INITAL
I agree to keep my child home or make other arrangements if s/he is not well enough to fully participate in daily activities and am prepared to pick up my child if ill within 45 minutes of Club contact.*
INITAL
I will call the appropriate BGC Niagara Unit if my child will be absent for any reason understanding that I will be charged the daily fee.*
INITAL
I understand a guaranteed spot in care must be paid for in advance. 2-week written notice must be given to the Club reception for any child being withdrawn. I understand that parents not giving 2 weeks' notice are financially responsible for those 2 weeks of fees.*
INITAL
I have read the Zone Parent Handbook and understand the policies and procedures as it pertains to my child's care at the BGC Niagara.*
INITAL
I have read, understand and authorize the administration of over-the-counter products I may send with my child, if my child is unable to self administer.*
INITAL
SIGNATURE*

Clear
DATE*

MonthDayYear
Date
Should be Empty:

Kids Zone and Teen Zone Registration Package 2025-2026

ZONE REGISTRATION & CONTACTS

PERMISSION & WAIVERS

ZONE REGISTRATION & CONTACTS

ALLOWABLE PICK UPS AND EMERGENCY CONTACTS (other than guardians; will call guardians listed in Part 1 first in case of emergency)

SAFE ARRIVAL/SAFE RELASE & PARENT HANDBOOK

AFTER READING THE ZONES PROGRAM PARENT HANDBOOK, PLEASE INTIAL BELOW:

SPECIAL REQUIREMENTS

SPECIAL REQUIREMENTS

ADDITIONAL SUPPORT - PLEASE INDICATE THE LEVEL OF SUPPRT NEEDED IN THE FOLLOWING AREAS:

MEDICATION DESCRIPTION

PARENT HANDBOOK

FINANCIAL AGREEMENT AND ACKNOWLEDGEMENT OF RULES AND REGULATIONS