Clone of '25-'26 Discovery Club Registration

DISCOVERY CLUB - SCHEDULE REQUEST

School Year 2025 - 2026 or Summer 2026
Child's Information
New member registration -- NO VOUCHER

Yes
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Child's Grade in Fall 2025*
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Home Phone Number*
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com

DISCOVERY CLUB - ENROLLMENT FORM

2025- 2026 School Year
If you have questions when filling out the forms, please contact discovery@bgcmetrowest.org or 508-485-4912.
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Child's Age at Admission*
Date

MonthDayYear
Date
Language Spoken at Home*
Child's Additional Information
Identifying Marks*
Allergies*
Special Diet*
Physician/Clinic Name*
Physician/Clinic Phone Number*
Physician/Clinic Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Eye Color*
Hair Color*
Ethnicity/Race*
Sex Assigned at Birth*
If your child's gender is different than their sex assigned at birth, please email us with this information.
Height*
Weight*

Parent / Guardian Information

Parent/Guardian 1
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 1 Relationship to Child*
Parent/Guardian 1 Home Address*
Parent /Guardian 1 Home Phone Number
Parent/Guardian 1 Cell Number*
Parent/Guardian 1 Email Address*
Parent/Guardian 1 Business/Work Name
Parent/Guardian 1 Work Address
Parent/Guardian 1 Business/Work Phone
Please enter a valid phone number.
Parent/Guardian 1 Hours at Work

Add an additional parent/guardian
Parent / Guardian Information

Parent/Guardian #2
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Relationship to Child
Parent/Guardian 2 Home Address
Parent/Guardian 2 Home Phone Number
Parent/Guardian 2 Cell Phone Number
Parent/Guardian 2 Email Address
Parent/Guardian 2 Business/Work Name
Parent/Guardian 2 Work Address
Parent/Guardian 2 Business/Work Phone Number
Please enter a valid phone number.
Parent/Guardian 2 Hours at Work

Child's Physical Examination & Immunization Records
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 in accordance with public health requirements are on file at my child's school.*

Clear
Parent / Guardian Signature
I certify that I have completed the Enrollment Form*

Clear
Date

MonthDayYear
Date

DISCOVERY CLUB - FIRST AID & EMERGENCY CONSENT FORM

School Year 2025-2026 OR Summer Program 2026
Chronic Health Conditions*
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*

Add additional emergency contacts
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 Number*
Your child's registration is considered INCOMPLETE without their full policy number on file!
I certify that I have completed the First Aid & Emergency Consent Form*

Clear
Date Valid Current School Year

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.
- I give permission for my child to be released from the program at the end of the day as stated below 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.
Parent/Guardian Signature*

Clear
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

Add additional transportation contacts
Transportation Contact #2
Name
Home Phone Number
Work Phone Number
Cell Phone Number
Relationship to Child
Transportation Contact #3
Name
Home Phone Number
Work Phone Number
Cell Phone Number
Relationship to Child
Date Valid Current School Year

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

Deposit / Registration Payment

PLEASE NOTE: If you do not want to pay via credit card today, please click the "Preview PDF" to print these documents. Then you can mail or drop off at the Pleasant St. Boys & Girls Club a check or cash payment.

My Products

Discovery Club Registration Fee 2025-2026

$75.00

Total

$0.00

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

Should be Empty:

	Monday	Tuesday	Wednesday	Thursday	Friday
Before School
After School

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

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

Deposit / Registration Payment