BGCHC Afterschool & Summer Registration

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If my contact information (home phone, cell, address, etc.) changes I will let the Boys & Girls Clubs know immediately. This is a very important safety Issue
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The Boys & Girls Clubs of Highlands County will maintain all member files in a confidential manner. I give permission for pertinent information (i.e. all academic information, report card information, behavioral reports, state testing IEP: FCAT, F.A.S.T. Stake Holders Survey, School ID # FL ID # or tutorial information) may be shared professionally with Boys & Girls Clubs staff members and Program Partners Permission for the sharing of this information is a requirement for child’s participation in some grant-sourced activities and programs, without which the child may be limited in receiving the full aspect of BGCHC programming.
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I understand that access to Boys & Girls Clubs' network and the Internet are designed for educational purposes and the Boys & Girls Clubs have taken precautions to educate members on appropriate educational materials. However, it is understood that no matter how much supervision and monitoring that the Club can utilize, there will always be the possibility of my child coming in contact with inappropriate material, and I will not hold the Boys & Girls Clubs responsible for materials acquired on the network.
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Member Information

Parent / Guardian Information

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Additional Household Information

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I will participate and attend Parent/Guardian Orientation and agree to participate and attend at least four (4) Adult Family Member Literacy Education Events during the School Year. Attendance will be documented by sign-in rosters and completion of an event survey. Annual Orientation must be completed before my child can start attending the Boys & Girls Club. Adult programs will be scheduled, and the parent will be given the date and time. I understand that if I cannot make the orientation that my child cannot start attending the Club until another orientation is rescheduled and attended. This includes any member past or present.
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Field Trips Permission Form

Household Information

I give permission for my child to participate in Member Assessments.
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Authorized Pick Up #2

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Club Members may have opportunities to expand their learning and life experiences by attending field trips to other BGC locations or educational venues in and outside Highlands County. These may include trips to museums, theatre productions, parks, art galleries, library, sports fields, swimming pools, special events. Field trip activities will be scheduled in advance and attendance may be offered on a space available basis, and as determined to be age-appropriate per the discretion and planning of the Site Director. Special event costs or fees may apply.

I give permission for my child to participate in prevention programs
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 (If no allergies or medical problems, please indicate NONE in the boxes below)
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Authorized Pick Up #1

Club Members are requested to participate in Progress Assessments during the school year and summer that will measure individual and group progress in areas of academics, behavior, fitness and enrichment. These assessments will include but not be limed to: Surveys for outcome measurements, schools’ grade and progress report cards, household demographics, and customized surveys built for specific programs (i.e. SMART Moves). Survey information is collected in aggregate and reported anonymously for purposes of program management and funding sources requests.

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Emergency Contact Information

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The Boys & Girls Clubs of Highlands county teaches preventative programs called SMART Families & Gang Prevention. Both programs help young people resist the most immediate threat to their wellbeing: premarital sex, alcohol, gang involvement, tobacco and other drugs. The programs are designed to reduce member's vulnerability by giving them the tools they need to help themselves. The Club also does a bullying prevention program that teaches youth how to not be a bully and what to do if you are being bullied

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I request my child be admitted to membership in the Boys & Girls Clubs of Highlands County. It is expressly understood and agreed by the undersigned that the Boys & Girls Clubs of Highlands County is not liable for the loss of property or injury unless such loss or injury results directly from Boys & Girls Clubs of Highlands County negligence or the willful act of an employee of the organization.


I also grant the Boys & Girls Clubs of Highlands County permission to authorize and obtain medical care in case of illness and injury when neither parent/guardian is available to grant permission for emergency treatment. I understand that the membership dues are not refundable at any time for any reason. Under the open door policy, it is understood and agreed that all members may come and go, as they desire. Therefore, the Boys & Girls Clubs of Highlands County will not be held liable for your child leaving the building and or/grounds.

Use of Name, Photograph and Identity in Connection with Advertising and/or Promotion of the organization or any of our partners.

 Rules, Waivers & Regulations

I will respect the Hours of Operation of BGC of Highlands County and I also understand that I will incur a late fee of $25.00 anytime I arrive to pick up my child(ren) after 6:00 pm. All late fees are due the day of the infraction. If late fees are not paid, I understand this can result in my child’s membership being suspended.
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Authorized Pick Up #3

Assessment

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Media Permission Form

Parent / Guardian Information

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I hereby irrevocably consent to and authorize the unrestricted use by BGC of Highlands County/ or partnering agencies of my child's name, photographs, works of art and identity in various BGCHC website, social media and collateral material, as well as miscellaneous print publications and other media outlets.
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I understand that my child's membership may be suspended or cancelled any time, the sole decision resting in the judgment of the Director.
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I give permission for my child to participate in any Field Trips.
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PLEASE NOTE ALL FEES ARE NON-REFUNDABLE. BY SIGNING BELOW YOU ARE STATING THAT YOU UNDERSTAND THIS POLICY.

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Government Assistance - Household Receives?
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Member's Medical Concerns

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Can you provide legal documentation if asked?
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I HAVE READ THE COMPLETED APPLICATION AND UNDERSTAND THE RULES OF THE BOYS & GIRLS CLUBS OF HIGHLANDS COUNTY AND REQUEST THAT MY SON/DAUGHTER BE ADMITTED INTO MEMBERSHIP. I HAVE EXPLAINED THE RULES TO MY SON/DAUGHTER AND AGREE THAT THE BOYS & GIRLS CLUBS OF HIGHLANDS COUNTY WILL NOT BE RESPONSIBLE FOR ANY ACCIDENT TO THE BOY/GIRL WHILE ON ANY OF OUR PREMISES OR WHILE ENGAGED IN ANY ACTIVITIES AWAY FROM BOYS & GIRLS CLUBS OF HIGHLANDS COUNTY.

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Additional Pick Up Information

School Data Release Form

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Prevention Programs

Hours of operation – Unless otherwise noted:

  • School Year: Afterschool 2:00 to 5:30 pm
  • Summer Program: Daily 8:00 am to 5:00 pm.
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Persons, other than parent/guardian, that is authorized to pick up member
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I fully understand and agree to all of the conditions stated on this form and have counseled my child to conform to these rules and the authority of the employees of the organization.
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In case we can not reach you
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BGC of Highlands County has a no nit and no lice policy. If your child is found to have lice or nits, they will need to be picked up immediately and may not return until their head is clear of lice and nits. I understand that if Club staff contact me regarding my child being sick or hurt that I will pick up my child immediately or make arrangements for them to be picked up.
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For valuable consideration I, the undersigned, hereby irrevocably consent to and authorize the unrestricted use by Boys & Girls Clubs of Highlands County/ or partnering agencies of my child's name, photographs, works of art and identity in various BGCHC website, social media and collateral material, as well as miscellaneous print publications and other media outlets, and any personal information that I supply to the Companies, in connection with advertising and promotion of the Companies and/or their products in any media, form or material selected by the Companies, without any right of prior review or further approval, whether such advertising and promotion is to the public, to the trade, or both, and in the corporate releases, newsletters and other communications of the Companies; and I hereby waive, and release and discharge said Companies and all agents, employees and officers of the Companies, including their agencies, media producers and customers from, any claims, liabilities and demands, past, present or future, including any that I do not now know of or anticipate arising in the future, none of which would affect my execution of this release if known to me, and waive all rights with respect to such use of my name, photograph, identity, and personal information including but not limited to publicity, privacy, psychological injury and libel.

***All new Members Under 8 require proof of age upon registration***

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Member Permission Forms

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The positive place for kids is open This SUmmer

Instructions

Fill out this application completely or download the paper application. One Application Per Child in Each Household. Children are enrolled as members to the Boys & Girls Club of Highlands County after-school program on a space-available basis. Separate Registration is REQUIRED for children to attend during the School Year and again for Summer Program. After-School Memberships start in August and end in May. Summer Programs Memberships Start in June and end in July.

Cost Fees & Contributions

Boys & Girls Club of Highlands County is supported by your community to provide our Club Experience to all school age children. It is expected that Parents and Guardians will join in this support to our membership.


PLEASE NOTE: A non-refundable, per session (School year / Summer) A Membership Dues / Registration Donation $65 PER CHILD is requested. (Unless awarded by membership scholarship [*], discounts do not apply for Multiple children in SAME HOUSEHOLD). This is to be paid at this time of application or in a payment order that will be set up between you and the

Clubs Site Director. Note: A $25.00 Late Fee Pick up Fee is assessed after 6:00pm.

Confidentiality

Any confidential information requested is for our records and for the funding our organization receives. The answers you provide will be kept completely confidential. Your cooperation in providing this information is both appreciated and necessary.

I am enrolling my child for Afterschool at the

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Avon Park Center

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207 E State St, Avon Park, Florida 33825, United States

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2:00 PM - 6:00 PM (School Year)
8:00 AM - 4:00 PM (Summer)

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863-452-4414

Sebring Center

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111 Martin Luther King Junior Boulevard, Sebring, Florida 33870, United States

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2:00 PM - 6:00 PM (School Year)
8:00 AM - 4:00 PM (Summer)

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863-385-9652

Ready to Get Involved?

Whether you want to enroll your child, make a donation, or volunteer your time, there's a place for you at Boys & Girls Club of Highlands County.