REGISTRATION FORM - YOUTH

MEDICAL INFORMATION

PLEASE NOTE: If you answer ‘yes’ to any of the questions below, a Care Plan is required to best support the health and safety of your youth. A staff member will contact you shortly.

CONTACTS

PARENT OR LEGAL GUARDIAN

EMERGENCY CONTACTS

WAIVERS

(Please check the appropriate boxes below)

PERMISSION TO TRANSPORT
I give permission for my youth to travel in vehicles operated by BGC Kamloops staff for the purposes of pickups, field trips, outings, and emergencies. I understand that the driver is fully qualified to operate Club vehicles and that seatbelt use is strictly enforced.

VISUAL IMAGE PERMISSION
I give my permission for my youth to be included in visual images (e.g., photos, videos, etc.) that may be used for BGC Kamloops marketing and communication purposes (e.g., website, brochures, posters, social media, television, etc.). Please note: All images will be used respectfully and will not include full names.

YOUTH LEAVING THE CLUB/DROP-IN
Youth can choose when they come and go from Club programs. Club staff will not prevent your youth from leaving the Club, however youth are encouraged to communicate with their parents/guardians about their whereabouts.

MEDICAL WAIVER
To the best of my knowledge, I have fully disclosed any physical and/or health issues that could potentially affect my youth’s participation in Club programs or activities. I authorize the Club staff to obtain medical advice and services as they deem necessary for the health and safety of my youth. In cases where my medical consent is needed, I authorize the BGC Kamloops staff to provide medical consent when all reasonable attempts to contact me, another parent/guardian of my youth, or an emergency contact has failed, as well as in the case of a medical emergency when there is not enough time to contact me, another parent/guardian of my youth, or an emergency contact. I accept full financial responsibility for all medical costs that exceed coverage provided by the British Columbia Medical Services Plan.

RELEASE OF LIABILITY
I acknowledge that by contracting with the BGC Kamloops, I am aware of the risks involved in the activities my youth/minor will be participating in at the Club. In consideration of my youth being permitted to come onto the property owned, leased, or contracted by the BGC Kamloops, and participate in programs and services contracted by myself, I hereby agree to release and discharge BGC Kamloops’ officers, servants, funders, volunteers, Club members, and employees from all liability claims and courses of action of any nature whatsoever in the event of any accident, injury, or sickness regarding my youth/dependent, myself, any spouse of mine, and any member of my family arising out of such use of properties and services of the BGC Kamloops.

AGREEMENT TO FOLLOW GUIDELINES FORM
BGC Kamloops operates Club programs and services within the terms of their program operations and behavioural guidelines. It is required that all parents/guardians understand and comply with these guidelines. A copy of the Clubs’ program guidelines will be provided upon registration and is available at the John Tod Club administration office.

CONSENT TO SERVICE
The Club requires written consent from a parent/guardian for minors (minors are defined by the legislation in your Club's province/territory) to receive service.

YOUTH PROGRAMS AND SERVICES

All youth program and services are drop-in style. Please visit our website for details on specific dates and times of operation – www.bgckamloops.com/youth-programs

PAYMENT INFORMATION

All youth programs and services are provided at no cost.

SIGNATURES

Name of Parent/Legal Guardian: {name-7} {name-6}