Virtual Evening Adventure Registration

Evening Adventures - Virtual Sessions

Participants must have a valid membership in order to participate.
Participants must be members* of the Boys & Girls Club of London

Until further notice, we will be offering virtual Evening Adventure sessions for children in Grades 1 to 8.

Join our staff on Mondays to Fridays from 5:30 p.m. to 7:00 p.m.

Please note: Access to a computer (or a device that has a webcam and microphone) and internet connection is required. If accommodations are required, contact Nadine Harrison at nharrison@bgclondon.ca.

To register for a membership, please visit our website - www.bgclondon.ca/memberships.

Children in Grade 5 with a valid Act-i-Pass may register for a free Boys and Girls Club of London membership. For more information or to register for an Act-i-Pass, please visit their website here - https://theheal.ca/projects/actipass/. Act-i-Pass holders must complete the PDF version of the Boys & Girls Club of London membership contract.

This program is supported by Jumpstart Sport Relief Fund. For more information, please visit their website.

While our Club is closed, we will be offering virtual Evening Adventure sessions for children in Grades 1 to 8 until further notice.

Children can register to join our staff Mondays to Fridays from 5:30 p.m. to 7:00 p.m.

Children MUST be members to participate.
Select a day: *
Do you have a computer, laptop, Chromebook or device for your child to use for this program? *

Yes No
Do you have access to the internet? *

Yes No
If you are in need of a device for your child(ren) or access to the internet, our staff will be in contact with you directly to assist you with this.

Devices can be borrowed but must be returned to the Boys & Girls Club of London in the same condition it was taken.

Parent/Guardian #1: Name *

First Name Last Name
The e-mail address you provide will be the e-mail address that our staff will be used to send e-mails and correspondence. Please ensure that our e-mail addresses are added to your contact list - virtualcamp@bgclondon.ca, npariseau@bgclondon.ca, wgrabriel@bgclondon.ca, and nharrison@bgclondon.ca.
Parent/Guardian #1: Email *
example@example.com
Parent/Guardian #1 Phone Number: *

Area Code Phone Number
Is there another parent/guardian in the household you would like to list? *

Yes No

Parent/Guardian #2: Name (optional)

First Name Last Name
Parent/Guardian #2: Email (optional)
example@example.com
Parent/Guardian #2: Phone Number (optional)

Area Code Phone Number

The next two sections will ask you for your electronic signature.

How do I create an electronic signature?

Use your cursor to draw your signature (if using a desktop computer).

OR

Draw your signature using your finger (if using a phone/tablet).

Please read each section carefully.
BOYS & GIRLS CLUB OF LONDON – VIRTUAL EVENING ADVENTURE

RELEASE OF LIABILITY, WAIVER OF CLAIMS

ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT.

BY SIGNING THIS AGREEMENT YOU WILL WAIVE CERTAIN

LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE

PLEASE READ CAREFULLY!

General Waiver

PLEASE NOTE THE FOLLOWING:

I have read the completed contract; understand the rules of the Boys & Girls Club of London and request that my child(ren) be admitted into this program / event / activity.

I have explained the rules to my child(ren) and agree that the Boys & Girls Club of London Foundation will not be responsible for any accident to my family on the premises or while engaged in any activities away from the Boys & Girls Club of London.

I, the undersigned, the parent / guardian of the above-named child do hereby consent to this child’s participation in the Boys & Girls Club of London’s programs.

I acknowledge that participation in these programs involves light to vigorous activity and includes the possibility of injury.

I grant program officials the authority to obtain emergency medical treatment as necessary to ensure that the above-named child is safe from further injury.

I am aware of no physical or other reasons why this child should not participate in club programs and related club functions. The risk of sustaining injuries results from the nature of the activity and can occur without any fault of either the Member, the Boys & Girls Club of London, Boys & Girls Club of London Foundation, its employees / agents or the facility where the activity is taking place.
Signature *

Clear
Full Name (Person Signing Release of Liability, Waiver of Claims Assumption of Risks and Indemnity Agreement.) *

First Name Last Name
Today's Date

Month Day Year
Date Signed

BGCL Virtual Evening Program

Guidelines & Disclaimer

PLEASE READ CAREFULLY!
In an effort to continue to provide service during COVID‐19, the Boys & Girls Clubs of London (BGCL) is providing programming and services virtually/from a distance. BGCL will use software and applications provided by third parties that participants, parents/guardians, and/or staff will access via the Internet for purposes of communication, programming, and receiving services.

These platforms will primarily include (but are not limited to) Microsoft Teams and Zoom. Our commitment to keeping the people we serve safe is always our number one priority.

To make all Boys & Girls Club of London (BGCL) programs safe, supportive, productive, and the best experience possible for individuals, group members and staff, it is important for each participant to make a commitment to adhere to the following guidelines:
- Please email the program staff about helpful tips and suggestions ahead of the online meeting if you need assistance.
- Mute your computer/phone while you aren’t speaking to keep background noise at a minimum. You can also chose to disable the video option should you choose.
- We encourage as much confidentiality and anonymity as possible.
  - Participants are asked to refrain from disclosing unnecessary personal or identifying information regarding themselves or others. Use statements like “my friend” or “my classmates” as opposed “Johnny from my school”.
  - Parents/caregivers - please refer to your kids as my “son/daughter” or the age of the youth, “my 15-year-old” in order to maintain the anonymity of minors.
Confidentiality:
- Participants should not activate the private chat option. Please use the main group chat to ask a question and/or request an opportunity to speak to avoid talking over one another.
- The use of earphones can help ensure confidentiality.
- We ask that you not record any part of the online meeting. We have purposely disabled these options whenever possible on the online platform but ask you do not record the conversation or meeting using any other recording devices (cell phone, etc.).
- The BGCL may record parts or all of an online meeting for supervisory purposes, and/or in the event of a disclosure/incident where other authority figures will need to be involved (i.e. EMS, Police, Fire). These files will be stored on the company’s secure cloud-based server (called SharePoint) to ensure the safety and security of all documents, photos, videos and files. All session recordings will always be uploaded to the cloud-based system (SharePoint) immediately once the session concludes. Folder restrictions will be in place for safety and security purposes of all parties.
Further, all activities online must comply with BGCL’s safety policies, including the Code of Conduct. Please complete the following form to record your consent for the use of BGCL’s virtual programming. If you have any questions, please feel free to contact the BGCL or Program Manager.

E-mail: nharrison@bgclondon.ca

Phone: 519-434-9115 ext. 238
I acknowledge that:
- I have been advised that the Boys & Girls Club of London (BGCL) will make every attempt to respect my privacy and boundaries. I understand that the BGCL cannot guarantee strict confidentiality.
- I understand that the BGCL will use a third-party video conferencing solution to facilitate the virtual group meetings. Although these calls may be encrypted for protection from malicious eavesdropping, the BGCL cannot guarantee this. By participating in the call, each member has reviewed and accepted the security of the facilitating platform (i.e. Zoom).
- Participants and their families are forbidden from recording online sessions in any way. Personal confidential notes are ok.
- Staff cannot reveal information about members without written permission except where disclosure is required by law:
  - Anyone who indicated they wish to harm themselves or others
  - If there are suspicions of abuse of a minor
- Self-Care in Emergencies: If at any time a participant feels like harming themselves or injuring others, they will call 911 or go to the nearest hospital emergency room. If the Parent/Guardian is not able to respond, the BGCL staff will be contacting 911 on behalf of the participant.
Parent/Guardian Consent
I give permission for the listed BGCL member/participant to participate in distance‐based online Club experiences at the Boys & Girls Club of London. I have fully read the disclaimer and acknowledge the information and guidelines that have been outlined.

Signed {dateIn}
Type your initials to show that you have read and understand the statement in the box above. *
Child's Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Date of birth for the child *

Month Day Year
Parent / Guardian's Full Name *

First Name Last Name
Parent / Guardian's Phone Number *

Area Code Phone Number
List all allergies, food allergies, and/or medical conditions which may impact your child's ability to take part in activities. Please type "None" if there are none. *
Please type "none" if there are no medical conditions.
Signature *

Clear
Full Name (Person Signing Virtual Programs Disclaimer) *

First Name Last Name
Date

Month Day Year
Date Signed
EXPECTATIONS OF FAMILIES INVOLVED IN VIRTUAL PROGRAMS TO KEEP IT SAFE:

In order to ensure that this program is as safe as possible for all participants and staff involved, we expect the following of families involved:
- ADULT AT HOME: An adult is required to be home during each session. Ontario has set age at 16 for when youth can stay home alone, although Canadian social services organizations advise that children under 12 years should not be left at home alone.
- BACKGROUND MATTERS: Participants need to be encouraged by parents/guardians to make their video background as plain as possible, or to create a virtual background if possible, to avoid the contents of their home from being seen.
- NO PERSONAL INFORMATION: Participants need to be encouraged by parents/guardians never to ask or share personal information such as address and phone number during a session.
- SHOW KINDNESS AND RESPECT: Participants need to be encouraged by parents/guardians to be a positive member of their group – respecting staff, fellow participants and all of the rules.
- BE ON TIME: Parents/guardians and participants need to work hard to arrive at each session on time. This enables participants to participate in the full program activities on offer – as well as ensures that staff can lock the session to make sure it is safe.
BEHAVIOUR EXPECTATIONS WHILE IN PROGRAM:

At the Boys & Girls Club of London, we believe that in order to have a successful virtual program where participants feel safe and motivated to be their best; the online environment must one that promotes safety for all. Outlined below is a list of appropriate behaviours expected of all participants and staff which contribute to establishing a safe atmosphere for one’s self and others.
- RESPECT: Participants in the program are expected to treat their peers, staff and the space with respect. This includes words of encouragement, actively listening when others are speaking, and keeping the space a bully-free zone.
- PARTICIPATION: Participants are highly encouraged to participate in activities that are facilitated during program. Participating in activities allows participants to build relationships and try new things.
- CO-OPERATION: Each session of the virtual program(s) requires participants to be part of a team. Effective teams collaborate and cooperate. This means participants are expected to work together as a team to achieve various goals throughout the sessions – whether playing games, working on crafts, or challenging each other to grow.
- RESPONSIBILITY: Participants are expected to ensure that their parents know that they are joining the session and that they join each day on time. Being on time allows staff to lock the meeting and to ensure that everyone has a positive and full program experience. Participants are also expected to come with the materials required for the session and any project(s) that they have been working on during program.
CONSEQUENCES FOR INAPPROPRIATE BEHAVIOURS IN PROGRAM(S):

The Boys & Girls Club of London strives to create a safe and inclusive virtual space where participants feel motivated to succeed. Within our program(s), certain challenging behaviours can become problematic and disrupt the positive atmosphere we are trying to create. Listed below are inappropriate behaviours in program(s) that will not be tolerated:
- BULLYING: Our programs will not tolerate any form of bullying including emotional, psychological or cyber-bullying.
- FOUL LANGUAGE: Participants are expected to use language in program(s) that is free of profanity.
- DISRESPECT: The Boys & Girls Club of London will not condone participant who display blatant disrespect towards their peers and staff. This includes not following staff direction, not listening to others, and using hurtful language that puts a person down.
Participants who display any of these behaviours may be suspended from the Boys & Girls Club of London's virtual program.
Should be Empty:

Evening Adventures - Virtual Sessions