Children Program Registration 2020

Children's Program Registration

For Grades 1 to 8
Please Note: At this time, there will not be a limit to how many times your child(ren) can attend the program however, we reserve the right to revise this if there is a waiting list for children who would like to attend.

If any registered members miss three (3) days of programs without notifying the BGCL beforehand of their absence, their spot will be given to another member on the waitlist.

Please contact Nadine Harrison if you have any questions or concerns.

519-434-9115 ext. 238 or nharrison@bgclondon.ca
The Boys & Girls Club of London is looking forward to having your child(ren) join us for Evening Adventure!

Through safety measures, recommendations and policies provided by the municipality, public health, and our national organization, we have prepared to meet the standards and guidelines in order to open for children's programs. We appreciate your support and understanding as we all navigate through these changes that have affected our lives, especially our children.

The health and well-being of our children, families, and staff, is our top priority. Upon arrival at the Boys & Girls Club, you will discover many changes and new procedures put in place to ensure the health and safety of all those who enter our facility. We wish to advise you of what to expect to avoid surprises.
- New procedure for pre-screening before entering the buildings. New procedure regarding isolation if an individual displays symptoms of COVID-19.
- Encouraging frequent hand washing throughout the day by all participants and staff. Hand sanitizers stations have increased and are readily available at the BGCL.
- Multiple cleaning procedures of shared surfaces using approved products for disinfection by Health Canada.
  Additional staff are hired to clean and ensure the disinfection and sanitization of equipment, furniture, washrooms, and all high traffic shared surfaces.
- PPEs are provided to our staff and are mandatory to be worn when 2 metres (6 feet) physical distancing is not possible with children and other individuals. All staff have participated in training specifically in regard to these additional safety measures as well.
- All rooms and spacing are sanitized and reconfigured to ensure physical distancing and reduce the interaction between other cohorts of children.
- Drop off area is in the front lobby at the BGCL where staff will meet and escort participants, and parents/caregivers must depart after drop off.
- Any visitors, aside from the Boys & Girls Club of London employees, scheduled guests, and registered participants, are to remain outside of the building and cannot travel through the facility without permission by management.

We will be accommodating as many children as possible in a registered after school recreation program that will allow children to explore and engage with a variety of opportunities in a safe and responsible manner.

Unfortunately, this means that only current members of the Boys & Girls Club of London will be able to attend until further notice. For more information about our memberships, please click here.

We have also made the difficult decision to postpone the busing program until further notice. Parents and caregivers will be responsible for providing transportation to and from the Boys & Girls Club. We’re very sorry for any inconvenience.

Youth programs will be available online initially, then we will move to some in-person experiences as we can identify ways to do so responsibly.

The number of spaces is limited to 40 participants, Monday to Friday.

The Junior M.A.P. program will be able to accommodate up to 10 M.A.P. registered participants Tuesdays and Wednesdays.

For information about the Junior M.A.P. program or to register, please click here (opens in a new window).

Youth programming will be available for a number of youth per day on select days.

For more information about the Senior M.A.P. program or to register, please click here (opens in a new window).

If you need to save the form and continue filling it out at a later time, please use the "Save" button which can be found at the bottom of each page.

You will receive an e-mail from Jotform with a unique link that you will need to click on to continue your form each time you click on "Save".

Changes to your form are not saved automatically. You must click on the "Save" button in order to save all changes and to continue filling it out at a later time.

The information we collect is for our client records. The Boys and Girls Club only shares anonymous statistical information with our funders.

All fields marked with * are required.

Thank you!

IMPORTANT - Children's Program Changes
1. Evening Adventure is for Grades 1 to 8.
2. No extended care available – Program drop off is no earlier than 4:00 p.m. Pick up is no later than 7:00 p.m. All children must be picked up by 7:00 p.m. Due to these safety procedures, please expect a delay.
3. All participants are divided into cohorts of 10 children per cohort and supervised by 1 staff member and 1 cleaning staff. Please note that all siblings or individuals in the same household or as requested will be grouped together in the same cohort.
4. Physical spacing to encourage children to remain apart from one another during activities to support 2 metres (6 feet) physical distancing.
5. Participants will remain on-site as there will be no bus trips or out-trips. Based on the weather, cohorts will participate in general outdoor activities in Kaleidoscope Alley/Lion's Lane where permitted.
6. Swimming – The pool will not be available at this time.
7. Supper Club is available for an extra fee of $2.00 per child, per day. A Supper Club Pass is also available for purchase for $60.00 per child and is valid for the program year (September 2020 to June 2021). You can purchase a Supper Club Pass using this form. You will need your credit card or PayPal information to process payment.
8. Children must wear masks or face coverings while in the program. If they do not have a face mask or face covering, one will be provided for them to wear for the night. Masks can be removed during gym time as the space allows safe, physical distancing. Children are welcomed to and encouraged to bring and wear their own face masks.
Please type your initials here to indicate you have read the above changes. Then click on "I agree". *
Your initials = First letter of first name + First letter of last name

At this time, there will not be a limit to how many times your child(ren) can attend the program however, we reserve the right to revise this if there is a waiting list for children who would like to attend.

If any registered members miss three (3) days of programs without notifying the BGCL beforehand of their absence, their spot will be given to another member on the waitlist.
Did your child(ren) participate in a Boys & Girls Club of London program during the 2019-2020 school year? *

Yes No

How many children are you pre-registering for Evening Adventure? Children must live in the same household. *
Which day(s) of the week will they be attending? Please note: We will expect your children to participate in our program on the day(s) selected. Please notify the BGCL in advance if they will be absent. *

Mondays Tuesdays Wednesdays Thursdays Fridays
Will your child(ren) be eating in Supper Club? *

Yes No
You can purchase a Supper Club Pass for your child(ren) now or use this form to purchase one later. The fee is $60.00 per child, and it is valid for the current school year.

If you do not wish to purchase a Supper Club Pass, the child(ren) must bring $2.00 per person, per night they want to eat. Please provide the exact change.

Support Workers who are accompanying children will not be permitted to eat in Supper Club.
Would you like to purchase a Supper Club Pass for each child listed on this form? *

Yes No

CHILDREN'S PROGRAM POLICIES

Age Policy Our program is intended for children in Grades 1 to 8 only.

Children with Difficult Behaviour in Program

Parents will receive a phone notification, to inform them of their child in dealing with any difficult behaviour experienced at the Boys & Girls Club of London.

Illnesses (Cold, Flu, COVID-19)

To ensure everyone’s safety, all individuals entering the Boys & Girls Club must participate in an active pre-screening and members are required to have their temperature checked by an on-site Boys and Girls Club staff member EACH NIGHT THEY ATTEND PROGRAM.

Prior to joining Evening Adventure every night, our staff will be asking assessment questions that you can complete online or upon arrival. Completing this online will most likely shorten the wait time at drop off if completed correctly.

Our questions are relating to having symptoms, having previous contact with others who may have COVID-19, or have travelled outside of Canada. If any of the questions are answered yes, the staff will request that you delay your visit, consider visiting your health care provider and to stay at home.

All completed questionnaires are kept for our records for contact tracing purposes for the Middlesex-London Health Unit in case individuals need to be contacted due to an outbreak.

You can find the Health Screening Questionnaire HERE.

You will also receive a link to the Health Screening Questionnaire in your e-mail as part of the registration confirmation.
The following two sections use electronic signatures.

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

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BOYS & GIRLS CLUB OF LONDON

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 membership / visitor.

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 (Agreeing to General Waiver) *

Clear
Full Name (Person Signing General Waiver) *

First Name Last Name

BOYS & GIRLS CLUB OF LONDON

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!
Type your initials here to show that you have read and understand the statement above. *
Child 1's Name

First Name Last Name
Child 1's Birth Date

Month Day Year
Medical Condition which may impact Child 1's ability to take part in activities (see below). If NONE, please type your initials into the box. *
If None, enter initials
Child 2's Name

First Name Last Name
Child 2's Birth Date

Month Day Year
Medical Condition which may impact Child 2's ability to take part in activities (see below) *
If None, enter initials
Child 3's Name

First Name Last Name
Child 3's Birth Date

Month Day Year
Medical Condition which may impact Child 3's ability to take part in activities (see below) *
If None, enter initials
Child 4's Name

First Name Last Name
Child 4's Birth Date

Month Day Year
Medical Condition which may impact Child 4's ability to take part in activities (see below) *
If None, enter initials
Child 5's Name

First Name Last Name
Child 5's Birth Date

Month Day Year
Medical Condition which may impact Child 5's ability to take part in activities (see below) *
If None, enter initials
Child 6's Name

First Name Last Name
Child 6's Birth Date

Month Day Year
Medical Condition which may impact Child 6's ability to take part in activities (see below) *
If None, enter initials
Address *

Street Address

Street Address Line 2

City

Postal Code
Email *
example@example.com
Parent's Name *

First Name Last Name
Parent's Phone Number *

Area Code Phone Number
TO: Boys & Girls Club of London and the Boys & Girls Club of London Foundation (together the “BGCL”) and their directors, officers, employees, instructors, agents, representatives, volunteers, independent contractors, subcontractors, sponsors, successors and assigns (hereinafter collectively referred to as the “Releasees”).

COVID – 19 COVID-19 is a contagious disease (“Covid”). We care about you, your family, our employees and the public. We strive to obey the law and follow Covid guidelines and implement all risk mitigation measures. However there are significant health risks and high risk of transmission through physical or shared contact. COVID-19 is novel and, because it can be transmitted through physical or shared contact with another person, the risk of contraction from engaging in sport activities may be foreseeable.

ASSUMPTION OF RISKS

I am aware that the activities at the BGCL programs involve risks and dangers that may cause serious injury and even death, and loss or damage to personal property. These risks are inherent in the activities and cannot be eliminated without altering their character and value. The risks include, among others, the following: contracting Covid; moving about the BGCL premises; negligence on the part of myself and/or other participants; negligence of the BGCL and its staff, including the improper use of equipment; the breakage and failure of equipment and structures; over exertion, together with other risks which may be encountered and NEGLIGENCE ON THE PART OF THE RELEASEES, INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE.

The BGCL programs are designed for use by participants of average strength, mobility and fitness who are in good health. Several medical
conditions, including but not limited to obesity, high blood pressure, cardiac and coronary artery disease, pulmonary problems, arthritis, tendonitis, or joint and muscular-skeletal problems may impair the safety and well being of participants as may other medical, physical, psychological or psychiatric problems. All such medical conditions may increase the risk of participating in the programs and cause the participant to be a danger to themselves or others. Participants with underlying medical, physical, psychological or psychiatric conditions must evaluate their condition and their ability before choosing to participate in the programs. All participants must inform BGCL in writing of any such medical, physical, psychological or psychiatric conditions before participating in any programs. The Releasees reserve the right to prevent any person, for medical or safety reasons, from participating in the programs at any time.

I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH MY USE OF THE BGCL PROGRAMS AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE AND LOSS RESULTING THEREFROM.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration of the Releasees permitting my use of the BGCL PROGRAMS and other facilities at the BGCL (hereinafter referred to as “the BGCL Facilities”), I hereby agree as follows:
1. TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against the RELEASEES , and TO RELEASE THE RELEASEES from any and all liability for any loss, damage, expense or injury including death that I may suffer, or that my next of kin may suffer resulting from either my use of or my presence at or on the BGCL Facilities DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE UNDER THE OCCUPIERS LIABILITY ACT, RSO 1990, c.02 ON THE PART OF THE RELEASEES, AND ALSO INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE;
1. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to property of or personal injury to any third party, resulting from my use of or presence on the BGCL facilities.
I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.

Signed {dateIn}
Signature (Agreeing to Release of Liability, Waiver of Claims Assumption of Risks and Indemnity Agreement.) *

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

First Name Last Name
Todays Date

Month Day Year
Date in Text

You have chosen to add a Supper Club Pass for your child(ren). Your total amount is:
Total for Supper Club Pass(es)
Supper Club Pass Cost

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Children's Program Registration

Please Note: At this time, there will not be a limit to how many times your child(ren) can attend the program however, we reserve the right to revise this if there is a waiting list for children who would like to attend.

If any registered members miss three (3) days of programs without notifying the BGCL beforehand of their absence, their spot will be given to another member on the waitlist.

Please contact Nadine Harrison if you have any questions or concerns.

519-434-9115 ext. 238 or nharrison@bgclondon.ca

IMPORTANT - Children's Program Changes

Parent / Caregiver #1

ASSUMPTION OF RISKS