Registration

2023-2024 School Year / Summer Camp

2024 Summer Fun Camp

Step 1 of 10

FAMILY INFORMATION

(please provide all requested information)

PARENT/GUARDIAN’S NAME(Required)

First Last

Pref. Phone #(Required)

EMAIL(Required)

Relation to Child(Required)

Address(Required)

Street Address City State ZIP Code

Place of Employment(Required)

Work Phone(Required)

Work Hours(Required)

Work Address(Required)

Street Address City ZIP Code

PARENT/GUARDIAN’S NAME

First Last

Pref. Phone #

Relation to Child

Address

Street Address City State ZIP Code

Place of Employment

Work Phone

Work Hours

Work Address

Street Address City ZIP Code

TRANSPORTATION/FIELD TRIP PERMISSION

I hereby give my permission for my child to participate in the activities and programs of the Boys & Girls Clubs of Carroll County that necessitate transportation in vehicles. I understand that often local day trips will be unannounced. Out of town trips will be posted in advance. I understand that all trips will be under the supervision of the Boys & Girls Clubs of Carroll County staff. I will not hold the Boys & Girls Clubs of Carroll County responsible in case of an accident. Notice of all trips will always be available at the administrative office.

Parent Signature

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date

SWIMMING PERMISSION

I hereby give my permission and full consent for my child to participate in swimming activities at local pools and facilities as conducted by the Boys & Girls Club. I hereby fully release the Boys & Girls Clubs of Carroll County and its Directors, Instructors, Officers and Staff, from any cause of action, claim or liability for damages or expenses. These include, but not limited to any claims for personal injuries resulting or arising out of any swimming activity or related activities.

Parent Signature

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date

BOYS & GIRLS CLUB RIGHT TO REFUSE PICK UP OF CHILD

I understand the Boys & Girls Clubs of Carroll County may refuse to allow my child to be transported home by anyone (including myself) that they feel may have their driving ability impaired due to drugs or alcohol or other circumstances. I understand that this is for safety reasons only and that the Boys & Girls Clubs of Carroll County will contact another authorized individual included on this application to pick up my child. I further agree that any late fees incurred because of the situation will be my responsibility.

Parent Signature(Required)

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date(Required)

COMPUTER USE PERMISSION

I hereby give my permission for my child to participate in the activities and programs of the Boys & Girls Clubs of Carroll County that use the internet. I understand that all computer use will be under the supervision of the Boys & Girls Club Staff. I understand my child may only go to internet sites that are pre-approved by the Boys & Girls Club Staff. Any inappropriate use of the computer will result in suspension and may result in my child’s membership to be revoked.

Parent Signature

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date

SCHOOL INFORMATION

I give permission to the Boys & Girls Clubs of Carroll County and Carroll County School Public Schools to exchange information including report cards, regarding the minor child listed on this application. The purpose of the exchange is to help both organizations to do a better job of helping the student be successful in school, in the Boys & Girls Clubs of Carroll County and in life. This release is valid for one year and may be revoked at any time by contacting Carroll County School Public Schools or the Boys & Girls Clubs of Carroll County in writing.

Parent Signature

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date

SURVEYS & QUESTIONNAIRES

I, the parent/guardian of the minor child listed in this application, give permission for the Boys & Girls Clubs of Carroll County to Survey my child about his or her Club experience, behaviors, skills and attitudes using Boys & Girls Clubs of America’s National Outcomes Survey or other survey instruments.

Parent Signature

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date

BOYS & GIRLS CLUBS OF AMERICA

I give permission to the Boys & Girls Clubs of Carroll County to share information about the minor child listed on this application with the Boys & Girls Club of America (BGCA) for research purposes and/or to evaluate the program’s effectiveness. Information that will be disclosed to BGCA may include the information provided on this membership application form, information provided by the minor child’s school or school data collected via surveys or questionnaires. All information provided to BGCA will be kept confidential.

Parent Signature

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date

PHOTO/VIDEO RELEASE

I understand that from time to time, the Boys & Girls Clubs of Carroll County will have publicity photos and/or videos taken during programming for use in local media, brochures and on their website. I give permission for my child to be included in all photo opportunities with Boys & Girls Clubs of Carroll County and their partners.

Parent Signature

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date

BGCC SWIM WAVER

Dear BGC Summer Camp Family/Guardian,
One of the perks of our summer camp is that we get to go swimming throughout the summer! We need further information from you to make sure your registered member is safe while swimming this summer. To ensure the safest possible experience at the pool for your registered member, we are asking you to select which Swim Category we should classify your youth this summer.

Please read the categories below CAREFULLY.

RED: Needs flotation or otherwise supportive devices while in the pool. Water wings, puddle jumpers, flotation vest etc. These members will only be permitted in the shallow end while properly wearing their flotation device. BGC does not supply floatation devices, and this will need to be brought on the day of our scheduled swimming.

YELLOW: Developing swimmer. These individuals are developing their swimming skills. They are required to swim exclusively in the shallow end. No flotation device required. No use of the deep end.

GREEN: Strong and capable swimmer. This is a strong swimmer that does not have any swimming restrictions. During select swim trips, GREEN swimmers may be allowed in deep waters where they may not be able to touch the bottom (example: Beaver Dam).

Select the best ONE that you wish to categorize your youth this summer for our scheduled swimming trips.

Red

Yellow

Green

Parent Signature(Required)

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date(Required)

SIGNED AGREEMENT

These policies and procedures have been designed to ensure the safety of ALL Boys & Girls Clubs of Carroll County’s members. Please take the time to review them with your child. If you have any questions, please contact us at 410-386-0135 or rwarner@bgccarrollcounty.org

Parent Signature(Required)

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date(Required)

YOUTH CAMP HEALTH HISTORY CAMPER

Child's Name(Required)

First Last

Current Residence(Required)

Street Address City State ZIP Code

EMERGENCY CONTACT INFORMATION

Emergency Contact (Parent or Legal Guardian)(Required)

First Last

Phone(Required)

2nd Emergency Contact (Other than Parent Above)(Required)

First Last

Phone(Required)

Primary Care Physician or other provider of medical care(Required)

Phone(Required)

HEALTH INFORMATION

Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware?(Required)

Yes

Explain(Required)

Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child’s camp experience is positive?(Required)

Yes

Explain(Required)

IMMUNIZATION INFORMATION

For campers who currently reside within the United States, a United States territory, or the District of Columbia: Does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication?(Required)

Yes

List(Required)

For campers who reside outside the United States, a United States territory, or the District of Columbia: Attach record of vaccination or immunity on Department form MDH-896.

Parent Signature(Required)

By entering your name below and submitting this electronic application, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

First Last

Date(Required)

Summer Camp Fees

Each week of camp is $135.00*
There will be a one-time registration fee of $30 per child which also covers the 2022-23 Afterschool Program
A non-refundable $25 deposit/per week will be due upon registration
Before and After Camp Activities are available for $10/day per child

ALL PAYMENTS MUST BE COMPLETED BY CLOSE OF BUSINESS THE THURSDAY BEFORE EACH WEEK OF CAMP. Failure to prepay may result in a lost spot for that week.

Payments can be made by CHECK or CARD.

A merchant fee will be applied to ALL credit card transactions.

If you wish to avoid transaction fees, please be sure to bring in a check BEFORE close of business EACH THURSDAY!* A merchant fee will be processed for all credit card purchases.

Sibling Discount

1st Child $135

2nd Child $125

3rd Child $115

Costs

Weekly fees of $135.00 per child are due the Thursday before each camp week. A $25.00 non-refundable deposit is required for each week of camp you would like to reserve for your child. The deposit will be credited toward your weekly fee. Please refer to the payment schedule sheet included to ensure you are paid in advance. A $30 one-time registration fee due with application also covers the 2023-2024 After School Program.

Hours of Operations

The program will run Monday thru Friday 9:00 am-5:00 pm. For an additional fee of $10.00 a day per child, before and after care is available between 8:00-9:00 am and 5:00-6:00 pm.

Who can attend?

Your child can attend if they are 6-13 years old.

Medications

Staff members will NOT administer medications to your child. Inhalers and other medications will have to be self-administered! 9-1-1 will be utilized in the event of an emergency! Please ensure detailed information is provided on the medical forms.

Pickup

Your child must be picked up no later than 5pm. After 3 late child pick-ups past 5 pm, camper(s) will be asked not to return. A late fee will be assessed for any child picked up past 5:00 pm for summer camp and 6:00 pm for after camp activities. Beginning at 1 minute passed the closing time a late fee of $1.00 per minute per family will be charged.

Weekly Themes

Week 1

June 17th – 21st
Color Bash

Week 2

June 24h – June 28th
Animal Week

Week 3

July 1st – July 5th
“Party in the USA”

Week 4

July 8th – July 12th
Spirit Week

Week 5

July 15th – July 19th
Movies & Media

Week 6

July 22nd – July 26th
“Bounce Back” Week

Week 7

July 29th – August 2nd
Water Week

Week 8

August 5th – 9th
BGC Olympics

Week 9

August 12th – 16th
Around the World Week

Week 10

August 29th – 23rd
“Backyard Bash” Week

Please note that these activities/field trips are subject to change. There will be a monthly calendar published upon the start of summer camp.

The 2024 - 2025 After School Program Registrations will begin in August 2024. Please check back for more information

Boys & Girls Clubs of Carroll County | 410-386-0135 | info@bgccarrollcounty.org | 71 E. Main Street, Westminster, MD 21157 | Member of the Boys & Girls Clubs of America

Registration

2024 Summer Fun Camp

CHILD INFORMATION

SCHOOL INFORMATION

FAMILY INFORMATION

LATE PICK UP

PERSONS AUTHORIZED TO PICK UP CHILD INCLUDING YOURSELF

MEMBERS 13 & OLDER ONLY

HOUSEHOLD INFORMATION

MEDICAL INFORMATION

MEDICAL LIMITATIONS

BEHAVIOR

ALLERGIES

MEDICATION

MEDICAL EMERGENCY

LEGAL AND/OR BEHAVIOR ISSUES

TRANSPORTATION/FIELD TRIP PERMISSION

SWIMMING PERMISSION

BOYS & GIRLS CLUB RIGHT TO REFUSE PICK UP OF CHILD

COMPUTER USE PERMISSION

SCHOOL INFORMATION

SURVEYS & QUESTIONNAIRES

BOYS & GIRLS CLUBS OF AMERICA

PHOTO/VIDEO RELEASE

BGCC SWIM WAVER

SIGNED AGREEMENT

YOUTH CAMP HEALTH HISTORY CAMPER

EMERGENCY CONTACT INFORMATION

HEALTH INFORMATION

IMMUNIZATION INFORMATION

CARROLL HOSPITAL CENTER: CONSENT FOR THE TREATMENT OF MINORS IN PARENTS ABSENCE

Summer Camp Fees

Sibling Discount

Costs

Hours of Operations

Who can attend?

Medications

Pickup

Weekly Themes

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

Week 10