L.I.T SUMMER CAMP CONTRACT 2026
CAMP HOURS: 8:30AM-5:30PM AT THE EJ FREELAND CENTRE ONLY
PARTICIPANT FIRST AND LAST NAME:
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GRADE PARTICIPANT COMPLETED IN JUNE:
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PARENT/GUARDIAN FIRST AND LAST NAME:
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PARENT/GUARDIAN PHONE NUMBER:
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Format: (000) 000-0000.
PARENT/GUARDIAN EMAIL ADDRESS:
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example@example.com
PARENT/GUARDIAN FIRST AND LAST NAME:
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PARENT/GUARDIAN PHONE NUMBER:
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Format: (000) 000-0000.
SELECT SCHEDULE
MINIMUM 5 DAYS PER WEEK, BOTH WEEKS REQUIRED 2&3 OR 6&7
CAMP RUNS JULY 6-10 AND JULY 13 TO 17 OR AUGUST 3-7 AND AUGUST 10-14
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JULY 6-10 AND JULY 13-17
AUGUST 3-7 AND AUGUST 10-14
ALLOWABLE PICK UPS AND EMERGENCY CONTACTS (other than guardians): IN APPROPRIATE CALL ORDER, ID REQUIRED FOR PICK UP
Rows
FIRST AND LAST NAME
RELATION
PHONE
1
2
3
4
PAYMENT POLICY
PAYMENT FOR SERVICE IS DUE
BEFORE
THE 1ST AND 16TH OF EACH MONTH
MONTHLY FEES WILL BE DIVIDED EVENLY OVER 2 PAYMENTS
FULL CHARGES APPLY TO STATUTORY HOLIDAYS, SCHOOL PD DAYS AND CANCELLATIONS
ANY CHANGES TO THE PARTICIPANTS SCHEDULE MUST BE 2 WEEKS IN ADVANCE INCLUDING NOTIFICATION OF UPCOMING VARIABLE SCHEDULES
2 WEEKS NOTICE IS REQUIRED FOR WITHDRAWAL AND VACATION DAY REQUESTS
SUBSIDIZED PARTICIPANTS WILL BE RESPONSIBLE FOR THE FULL PAYMENT OF ANY ADDITIONAL SERVICE NOT COVERED BY SUBSIDY
SUBSIDIZED PARTICIPANTS WILL BE CHARGED PRIVATELY AND FEES DUE IMMEDIATELY FOR ANY DAYS BEYOND THE ALOTTED ABSENT DAYS
FAILURE TO COMPLY WILL RESULT IN THE TERMINATION OF CARE
I HAVE READ AND AGREE TO ADHERE TO THE PAYMENT POLICY STATED ABOVE. I AGREE TO ALL OF THE INFORMATION THAT IS WRITTEN ON THE CHILDCARE CONTRACT. I UNDERSTAND THAT A NEW CONTRACT MUST BE COMPLETED WHEN ANY CHANGES ARE MADE.
SIGNATURE:
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DATE:
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Month
-
Day
Year
Date
PARTICIPANT INFORMATION
PARTICIPANT DATE OF BIRTH:
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-
Month
-
Day
Year
Date
PARTICIPANT ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE:
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Format: (000) 000-0000.
START DATE:
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-
Month
-
Day
Year
Date
PARENT/GUARDIAN FIRST AND LAST NAME
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PHONE NUMBER:
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Format: (000) 000-0000.
PARENT/GUARDIAN EMPLOYER NAME:
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EMPLOYER PHONE NUMBER
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EMPLOYER ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT/GUARDIAN FIRST AND LAST NAME
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PARENT/GUARDIAN PHONE NUMBER:
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Format: (000) 000-0000.
EMPLOYER NAME:
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EMPLOYER PHONE NUMBER:
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EMPLOYER ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PART 2 PERMISSIONS & WAIVERS
I GIVE THE PARTICIPANT, AS NAMED ABOVE, PERMISSION TO PARTICIPATE IN THE FOLLOWING (INITIAL):
ANY TRANSPORT NECESSARY, WHETHER FOR MEDICAL TREATMENT OR CLUB USE
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INITAL
LEAVE THE CLUB WITH STAFF SUPERVISION
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INITAL
LEAVE THE CLUB WITHOUT STAFF SUPERVISION
INITAL
ATTEND ANY FIELD TRIPS PLANNED BY THE CLUB
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INITAL
UTILIZE THE CLUB POOL WHEN SCHEDULING ALLOWS
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INITAL
ANY MEDICAL TREATMENT REQUIRED
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INITAL
1. By selecting 'yes', I consent to the collection, use and disclosure of my personal information during the course of my or my child's membership/services for the purpose set out in the BGC Niagara privacy policy. By selecting 'no', I consent to the use of my personal information only for the purpose of permitting the BGC Niagara to communicate with me.
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YES
NO
2. I consent to my child's image being published in web or print directories for by the BGC Niagara and/or its branches.
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YES
NO
3. By selecting 'yes', I consent to my child's participation in the BGC of Niagara programs. By selecting 'no', I do not consent to my child participating in the boys and girls club of Niagara programs.
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YES
NO
YOUR SIGNATURE BELOW INDICATES YOU HAVE FULLY READ, UNDERSTOOD AND COMPLETED THE REGISTRATION FORM AND AGREE TO ALL PERMISSIONS AND WAIVERS CONTAINED HEREIN.
SIGNATURE:
*
DATE:
*
-
Month
-
Day
Year
Date
PARENT HANDBOOK
FINANCIAL AGREEMENT AND ACKNOWLEDGEMENT OF RULES AND REGULATIONS
After reading the Licensed Child Care Parent Handbook, please sign below. Your signature below indicates that you have fully read and understood the 2025-2026 Licensed Child Care 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.
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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.
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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.
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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. Full refunds (with a $25 processing fee per camper) for those cancellations requested on or before June 1st. Full refunds (with a $50 processing fee per camper/per week) for those cancellations requested between June 1st and two weeks before the start of camp. Full Camp fees non-refundable within 2 weeks of camp program commencement (ie. whoever is signed up for camp within 2 weeks of the start of summer will not be issued refunds [without extenuating circumstances as approved by a Director or Officer])
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I have read the Parent Handbook and understand the policies and procedures as it pertains to my child's care at the BGC Niagara.
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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.
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SIGNATURE:
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DATE:
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-
Month
-
Day
Year
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 13 kinder children ratio and 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:
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AGE OF PARTICIPANT:
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PARTICIPANT HEALTH CARD NUMBER:
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THIS SECTION WILL INFORM THE BOYS AND GIRLS CLUB 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 REQUIREMENTS OF THE PARENT IN OUT SOURCING SUPPORTS PRIOR TO COMMENCING SERVICES.
1. DOES THE PARTICIPANT HAVE ANY SPECIAL REQUIREMENTS?
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YES
NO
IF YES PLEASE SPECIFIY:
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2. IS THE PARTICIPANT NOW OR HAVE THEY EVER TAKEN ANY MEDICATION?
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PRESENTLY
PREVIOUSLY
NO
IF PRESENTLY, WHAT MEDICATION(S)?
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WHEN?
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HOW MUCH?
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REASON?
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3. ARE YOU RECEIVING SUPPORT SERVICES FOR THE PARTICIPANT AT THIS TIME?
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YES
NO
IF SO, FROM WHAT AGENCY?
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4. HAVE YOU RECEIVED SUPPORT FOR THE PARTICIPANT IN THE PAST?
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YES
NO
IF SO, FROM WHAT AGENCY?
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5. DOES THE PARTICIPANT HAVE ANY ALLERGIES?
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YES
NO
IS THE REACTION ANAPHYLACTIC?
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YES
NO
IF SO, WHAT ARE THEY AND WHAT IS THE LEVEL OF SEVERITY?
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ADDITIONAL SUPPORT - PLEASE INDICATE THE LEVEL OF SUPPRT NEEDED IN THE FOLLOWING AREAS:
DRESSING:
TOILETING:
MOBILITY:
COMMUNICATION:
FEEDING OR FOOD 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.
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Rows
NAME OF MEDICATION
DOSAGE (NOTE MG)
TIME TAKEN
DURATION
1
2
3
PARENT/GUARDIAN CONSENT
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 BOYS AND GIRLS CLUB OF 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 COMPLETED, 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:
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DATE:
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-
Month
-
Day
Year
Date
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