• 2026-2027 After School Care Membership

  • Each member will need a seperate form submitted. Please complete all forms for members attending the club before payment. Membership spot will not be reserved until the first month's payment has been made. If you have any questions email atchisonafterschoolclub@gmail.com . 

  • Birth Date*
     / /
  • Gender*
  • Nationality*
  • Do you receive assistance from the Atchison Housing Authority?*
  • Do you live in public housing?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Emergency Contacts

  • School Information

  • Family History

  • Does this person have legal custody/ guardianship*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Medical Information

  • Does your family have health and/or accident insurance?
  • General Information

  • My child has permission to use the internet during scheduled computer lab time.*
  • Has your child ever been a memeber of a Boys and Girls Club in the past?*
  • Confidential Information

    We are required to provide statistical information to our national office for continued funding. All identifying information is removed when statistics are reported. The answers you provide are confidential. We cannot continue to receive funding if you do not provide the requested information. We appreciate your assistance.
  • Household Income*
  • Please select any that you receive:*
  • Child family setting*
  • Policies and Permissions

    Please read the statements below.
  • Open Door Policy, Club Access

    I (we) hereby give permission for my child to take part in the 2026-2027 School Year program at the Atchsiosn After School Club. I understand that the Atchison After School Club will make every effort to keep my child from leaving the club building without permission; however, I also understand that the Boys & Girls Club of Atchison is a voluntary club not a daycare center. I understand that the club is not responsible for the time or manner in which my child may arrive or leave the club. If at anytime my child demonstrates that they do not want to be a part of the club program, I understand that I will be contacted and will then be responsible for making other arrangements.

    Medical Treatment

    I (we) permit and authorize the Atchison After School Club to allow necessary examination, anesthetic, medical diagnosis, surgery or treatment and/or hospital care to be rendered to the named physician or surgeon licensed to practice medicine. I understand that care for injuries that may occur during my child's active participation in Atchison After School Club are the responsibility of myself, my family, and or my insurance. I understand that the Atchison After School Club does not supply insurance for my child.

    Sick or Injured Children
    Sick children will be sent home from the club due to any illness that keeps them from fully participating in the program. After notification, Parents must pick up child within one (1) hour.
     
    Emergency Procedures 

    The following procedures will be taken when children develop health problems or become severely injured while in the program:

    1.    Parent will be contacted with the condition of the child.
    2.    Club staff will recommend whether a child is to be picked up.
    3.    Following an injury, an accident report will be written and kept on file. Parents will be provided with a copy as well.
    4.    In extreme emergency situations, an ambulance will be dispatched. Parents will be notified.

     
    Field Trips


    Field trips, when available, are one of the most exciting parts of the program. They are opportunities for vivid and memorable learning experiences. Children are eligible for field trips based upon behavior and participation.  

    Acceptable Use Policy

    The Atchison After School Club adopts this policy to maintain a safe and secure environment for members, staff, volunteers and others.
     
    A personally owned device includes all member-owned existing and emerging technologies and devices that can take photographs, play and record audio or video, input text, upload and download content and/or media, and transmit or receive messages or images.
     
    Emerging technologies and devices include but are not limited to cell phones, computers, tablets and storage media (e.g., flash drives), as well as communication tools including social media sites, text messages, chat and websites. Not all devices are covered within this policy. Unacceptable devices in this policy include, but are not limited to, gaming devices or consoles, laser pointers, modems or routers and televisions.
     
    Club purposes include program activities, career development, communication with experts and/or Club peer members, homework and Club activities. Members are expected to act responsibly and thoughtfully when using technology resources. Members bear the burden of responsibility to ask staff when they aren’t sure of the permissibility of a particular use of technology prior to engaging in the use.
     
    Personally owned devices are to be put away in a secure location during Club time. The Club expressly prohibits the use of personally owned devices in locker rooms, restrooms and other areas where there is an expectation of privacy. Members may have their phones on them during Club activities in extenuating circumstances if previous arrangements have been made between the parent and staff. 
     
    Any inappropriate use of a personally owned device, as determined by Club staff, can lead to disciplinary action including, but not limited to, confiscation of the device, immediate suspension from the Club, termination of membership, or other disciplinary actions determined to be appropriate to the Club’s existing disciplinary policies including, if applicable, referral to local law enforcement.
     
    Inappropriate communication includes, but is not limited to, obscene, profane, lewd, vulgar, rude, inflammatory, threatening, or disrespectful language or images typed, posted or spoken by members; information that could cause damage to an individual or the Club community, or create the danger of disruption of the Club environment; personal attacks, including prejudicial or discriminatory attacks; harassment (persistently acting in a manner that distresses or annoys another person) or stalking others; knowingly or recklessly posting false or defamatory information about a person or organization; and communication that promotes the destruction of property, including the acquisition or creation of weapons or other destructive devices. If a member is told to stop sending communications, that member must cease the activity immediately.
     
    Members may not use any technology to harass, threaten, demean, humiliate, intimidate, embarrass, or annoy their peers or others in their community. This behavior is cyberbullying, which is bullying that takes place using emerging technologies and devices. Examples of cyberbullying include mean text messages or emails; rumors sent by email or posted on social networking sites; and embarrassing pictures, videos, websites or fake profiles. Any cyberbullying that is determined to disrupt the safety and/or well-being of the Club, Club member, Club staff or community is subject to disciplinary action.
     
    Members must be aware of the appropriateness of communications when using Club or personally owned devices. Inappropriate communication is prohibited in any public messages, private messages and material posted online by members.
     
    Monitoring and inspection. Atchison After School Club reserves the right to monitor, inspect, copy and review a personally owned device that is brought to the Club. Parents/Guardians will be notified before such an inspection takes place and may be present, at their choice, during the inspection. Parents/Guardians may refuse to allow such inspections. If so, the member may be barred from bringing personally owned devices to the Club in the future.
     
    Internet access. Personally owned devices used at the Club are not permitted to directly connect to the internet through a phone network or other content service provider. Personally owned devices must access the internet via the Club’s content-filtered wireless network. Atchison After School Club reserves the right to monitor communication and internet traffic, and to manage, open or close access to specific online websites, portals, networks or other services. Members must follow Club procedures to access the Club’s internet service.
     
    Loss and damage. Members are responsible for keeping devices with them at all times. Staff are not responsible for the security and condition of the member’s personal device. Furthermore, the Club is not liable for the loss, damage, misuse or theft of any personally owned device brought to the Club.
     
    Parental notification and responsibility. AASC’s Internet Acceptable Use Policy restricts the access of inappropriate material. However, supervision of usage may not always be possible while members use the internet. Due to the wide range of material available on the internet, some material may not fit the particular values of members and their families. Because of this, it is not practical for AASC to monitor and enforce a wide range of social values in student use of the internet. If parents do not want members to access information beyond the scope of the Internet Acceptable Use Policy, parents should instruct members not to access such materials.

     
    Grievance Policy

    Parents are children who have a grievance against AASC that they're not comfortable discussing with the program director (the direct supervisor at the club)can submit their complaint to the Chief Executive Officer at 913-367-3233 - the complaint will be routed to in handled by the appropriate AASC management.

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