Student Name *

If adding more than one child - information can be collected after submission.

First Name

Last Name

Date of birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PARENT INFORMATION *

First Name

Last Name

Phone *

(###)

###

####

*

This will be main billing contact

AUTHORIZED PICKUP INFO *

First Name

Last Name

Phone

(###)

###

####

Liability Waiver *

I hereby certify that my child(ren) is/are in good physical condition and do/does not suffer from any disability that prevents or limits his/her participation in all activities conducted by BGC Prince County. I acknowledge that BGC Prince County will not assume any responsibility or liability for personal injury or damages caused by the injury. In the event BGC Prince County is unable to reach a parent, guardian or any emergency contact, I hereby give permission for my child(ren) to be transported to the nearest hospital for treatment in case of an accident or emergency. I hearby further authorize(s) any of the the staff or employees to provide for, approve and authorize health care at hospital.

I've read the above and agree

Fees and Registration *

I understand that there is a $25.00 annual membership fee for each child participating in BGC Prince County programs. I also understand that Summer Camp payments are due in advance and attendance can be cancelled and refunds issued up to the first day of Camp (June 27).

I've read the above and agree

Offsite and Field Trip Information *

While providing a safe, fun and engaging experience for each of our members in mind, we believe it is beneficial to have our members engaged in the community while being fully supervised and under the direction of our programming team at all times. With that said, we believe it is very important that our members’ parents and guardians are fully aware that safety is first and foremost for our members and that every outing is assessed by our team to ensure our members are playing and engaging in a safe environment. Additionally, we take all precautionary measures with all our vehicles to ensure that they are safe to operate on a daily basis (inspections, proper licenses, daily checks prior to utilizing the vehicle, proper equipment required for members while being transported, etc.). As per the Early Learning and Child Care Act Regulations, it is a requirement that we receive permission from parents and guardians to allow for their child to participate in outings. If you have any questions, please contact our Program Director at any time. Thank you!

I've Read the above and agree

Off Site Activities Release *

I understand that during programming offered at BGC Prince County, there will be times that members will have the opportunity to go on off-site activities within the Summerside area. Typical outings could be, but are not limited to, going to local parks, nature walks or scavenger hunts on the Confederation Trail, Credit Union Place, Green's Shore, or various Arts and Cultural events in the community. By checking the box below you indicate that you give your permission for your child to participate in any off-site activities. If you do not give permission, we ask that you please contact and inform the Program Director.

I've read the above and agree to give permission

Field Trip Release *

I understand that during programming offered at BGC Prince County, there will be times that members will have the opportunity to go on field trip outings outside the Summerside area. Field trips may be, but are not limited to, trips to Shining Waters Fun Park, Off the Wallz Trampoline Park or Victoria Park in Charlottetown. By checking the box below you indicate that you give your permission for your child to attend these field trips and to be transported there by our transportation services. If you do not give permission, we ask that you please contact and inform the Program Director.

I've read the above and agree to give permission