Clone of '25-'26 Discovery Club Voucher Registration

DISCOVERY CLUB - SCHEDULE REQUEST

School Year 2025 - 2026 or Summer 2026
Child's Information
VOUCHER

Yes
Child's Full Name*
Please include first and last name
Child's Grade in Fall 2025:*
Child's Date of Birth:*

MonthDayYear
Date
Parent/Guardian Information
Parent/Guardian Name:*
Parent/Guardian Home Phone Number:
Parent/Guardian Cell Phone Number:*
Parent/Guardian Email:*
example@example.com
School & Days for Attendance
Please select your child's school*

169 Pleasant St. (School Vacation Weeks and GAP Days only. PLEASE NOTE by selecting this option this does NOT register your child for these days. Separate registration is required.)

I'm requesting care for the following days/times:*

	Monday	Tuesday	Wednesday	Thursday	Friday
Before School
After School

Rates for Care

Questions about the schedule or rates? Contact Discovery Club at 508-485-4912 or discovery@bgcmetrowest.org

Before School	After School	Before & After School
5 Days - $214/month	5 Days - $493/month	5 Days - $678/month
4 Days - $180/month	4 Days - $440/month	4 Days - $592/month
3 Days - $157/month	3 Days - $382/month	3 Days - $504/month
2 Days - $133/month	2 Days - $273/month	2 Days - $378/month

No School Days with Trips	$81 / day
No School Days without Trips	$58 / day
Registration Fee (non-refundable)	$75 / year

Deposit Agreement
I understand the following:
- Registration payments are due at time of enrollment.
- Registration is non-refundable We require a fourteen (14) day written notice in the event that you need to withdraw from the program. Families who fail to comply with this requirement in writing will be charged an additional $150.
- Additions or changes to your child's schedule may be made at any time if space is available. You will be charged a $25 change fee for each schedule change. Monthly rates will not be prorated during the change month; the higher rate will apply.
- There will be no refunds, credits or pro-rating for missed days.
Parent/Guardian Signature*

Clear
Today's Date:

MonthDayYear
Date

DISCOVERY CLUB - FIRST AID & EMERGENCY CONSENT FORM

School Year 2025-2026 OR Summer Program 2026
Chronic Health Conditions*
If none, please write "none"
Emergency Contacts

I give permission for my child to be released to these contacts. Please list in order to be contacted.
Emergency Contact #1 - Name*
Emergency Contact #1 - Home Phone #*
Emergency Contact #1 - Work Phone #*
Emergency Contact #1 - Cell Phone #*
Emergency Contact #1 - Relationship to Child*
Emergency Contact #2
Emergency Contact #2 - Name
Emergency Contact #2 - Home Phone #
Please enter a valid phone number.
Emergency Contact #2 - Work Phone #
Please enter a valid phone number.
Emergency Contact #2 - Cell Phone #
Please enter a valid phone number.
Emergency Contact #2 - Relationship to Child
Emergency Contact #3
Emergency Contact #3 - Name
Emergency Contact #3 - Home Phone #
Please enter a valid phone number.
Emergency Contact #3 - Work Phone #
Please enter a valid phone number.
Emergency Contact #3 - Cell Phone #
Please enter a valid phone number.
Emergency Contact #3 - Relationship to Child
Public Relations & Field Trip Consent
I give consent to have my child photographed or videotaped for public relations purposes.*

YesNo
I give permission for my child to participate in field trips by means of bus/van and that I will be notified in advance of any trips.*

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 even 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.
Health Insurance Carrier*
Subscriber of Policy*
Policy #*
Your registration is considered INCOMPLETE without your child's full policy number on file!
Parent/Guardian Signature:*

Clear
Today's Date:*

MonthDayYear
Date

DISCOVERY CLUB - TRANSPORTATION PLAN/AUTHORIZATION

School Year 2025-2026
How will your child ARRIVE to the Program?
Before School Program

All children registered for the before school program must be dropped off at the program by an authorized person. Please select option 1.

After School Program

All children registered for the after school program walk to the program space (cafeteria) from their classrooms unsupervised unless otherwise stated by a guardian. Please select option 2 or 3.

Before AND After School Program

Please select option 1 AND option 2 or 3.

My Child will ARRIVE to the Program by:*

	Check ALL that apply
Parent/Authorized Drop Off (AM)
Unsupervised Walk to Discovery Club from Classroom (PM)
Supervised Walk to Discovery Club from Classroom/Other (PM)

How will your child DEPART the program?
Before School Program

All children registered for the before school program walk from the program space (cafeteria or gym) to their classrooms unsupervised at 8:40am unless otherwise stated by a guardian. Please select option 2 or 3.

After School Program

All children registered for the after school program must be picked up by an authorized person at the end of the day. If your child will be attending the after school program, select option 1.

Before AND After School Program

Please select option 1 AND option 2 or 3.

My child will DEPART from the program by:*

	Check ALL that apply
Parent/Authorized Pick Up (PM)
Unsupervised Walk from Discovery Club to Classroom (AM)
Supervised Walk from Discovery Club to Classroom/Other (AM)

If you selected "supervised walk/other" above, please indicate by whom or additional details:
Transportation Contacts

Please include anyone who you, as the parent/guardian, are authorizing to pick your child up from our program who is NOT listed as an emergency contact.
Transportation Contact #1
Transportation Contact #1 - Name*
If no one other than a parent/guardian/emergency contact is authorized to pick up your child, please type NO ONE.
Transportation Contact #1 - Home Phone #*
Please enter a valid phone number.
Transportation Contact #1 - Work Phone #*
Please enter a valid phone number.
Transportation Contact #1 - Cell Phone #*
Please enter a valid phone number.
Transportation Contact #1 - Relationship to Child*
Transportation Contact #2
Transportation #2 - Name
Transportation Contact #2 - Home Phone #
Transportation Contact #2 - Work Phone #
Transportation Contact #2 - Cell Phone #
Transportation Contact #2 - Relationship to Child
Transportation Contact #3
Transportation Contact #3 - Name
Transportation Contact #3 - Home Phone #
Transportation Contact #3 - Work Phone #
Transportation Contact #3 - Cell Phone #
Transportation #3 - Relationship to Child
Transportation Authorization
- 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.***
Parent / Guardian Signature
Parent/Guardian Signature:*

Clear
Today's Date:

MonthDayYear
Date
Completes "Consent for Child to Leave the School Age Child Care Program" form per CMR 7.04
Should be Empty:

DISCOVERY CLUB - SCHEDULE REQUEST

Child's Information

Parent/Guardian Information

School & Days for Attendance

Rates for Care

Deposit Agreement

DISCOVERY CLUB - ENROLLMENT FORM

Child's Additional Information

Additional Questions

Parent / Guardian Information

Parent / Guardian Information

Child's Physical Examination & Immunization Records

Parent / Guardian Signature

DISCOVERY CLUB - FIRST AID & EMERGENCY CONSENT FORM

Emergency Contacts

Emergency Contact #2

Emergency Contact #3

Public Relations & Field Trip Consent

First Aid & Emergency Medical Care Consent

DISCOVERY CLUB - TRANSPORTATION PLAN/AUTHORIZATION

How will your child ARRIVE to the Program?

How will your child DEPART the program?

Transportation Contacts

Transportation Contact #1

Transportation Contact #2

Transportation Contact #3

Transportation Authorization

Parent / Guardian Signature