Please Read Carefully
I have read and understand the Boys & Girls Club of Fond du Lac’s PBIS Expectations and Behavior Support Plan. I understand that all members are expected to follow these policies at all times when they are part of Boys & Girls Club activities. I understand the club reserves the right to search all personal belongings.Read the PBIS Expectations and Behavior Support here
In the event of an emergency I understand that every attempt will be made to contact me. If I cannot be reached I hereby give my permission to the physician selected by the Boys & Girls Club staff member to secure proper treatment for my child.
I understand that the BGCFDL has an open door policy. This policy means that my child is welcome at any time. It is my responsibility to be sure that my child understands their departure procedure from the Club. I understand that the Club is not responsible for my child once they have left the building. I also understand that if club staff are unable to contact a caregiver within 30 minutes of the end of Club programming, law enforcement and Child Protective Services may be notified.
I do give my permission to have my child appear in any media coverage for the Boys & Girls Club of Fond du Lac unless I have checked the box on the member information page stating that they may not appear in media coverage.
I authorize BGCFDL to transport my child on field trips by bus or van within the local city during normal Club operating hours.
I understand that enrollment in the Boys & Girls Club School Year program requires participation in academic enrichment activities and academic support.
I hereby give permission for the participant(s) listed on this application to take part in the Community Learning Center’s (CLC) activities, which may include off-site events, academic assistance, continuing education, and recreational programs. If a medical emergency arises, program staff will take all steps necessary to ensure the safety of the participant and will call if necessary, a public emergency vehicle for transport to an emergency facility. I understand that I will be responsible for any transportation charges and medical expenses incurred. I am aware of, and understand, there may be a potential risk inherent with participation in any activity and that the Fond du Lac School District and the City of Fond du Lac does not provide accident insurance and cannot assume responsibility for injury to any participants of any activities associated with the AfterSchool Club House Programs. I give my consent to the school district and Boys & Girls Club of Fond du Lac to share the participant’s student records with each other for purposes of providing educational support and assistance. In addition, I understand that school district and or Boys & Girls Club of Fond du Lac will use participant records to evaluate individual progress and improvement, as well as to evaluate the impact of the program on student achievement and to obtain continued funding for the program.
I have read and understand the program guide(s) for the programs my children are in: Click to read the Johnsonville Site Program Guide here.