In addition to legal/secondary guardian and emergency contacts listed, the following people are ALLOWED to pick up my child

The following people are NOT ALLOWED to pick up my child. Please submit any supporting legal documentation stating person cannot pick up.

I agree to follow the rules and policies explained in the Member Behavioral Expectations of Boys & Girls Clubs of Greater Manchester (BGCGM). I realize that membership to BGCGM is a privilege, and if my child/children or myself, can't follow the rules and policies, the Club membership could be in jeopardy, leading to possible removal. I understand that if a member is suspended or expelled from BGCGM's programs, a refund is not guaranteed and is at the discretion of management. I understand that under the behavior management protocol, BGCGM reserves the right to suspend a member from the program and bussing effective the next day, so it is my responsibility to make alternative care arrangements in advance. I know BGCGM has an opendoor policy for their Union Street Clubhouse for members in grades 6-12.

I understand that:

• BGCGM Union Street Clubhouse is not subject to licensure under RSA 170-E:4. Parents or guardians must go through the Director of Programs & Leadership or the Assistant Director of Programs & Leadership at 603.625.5031 with all grievances concerning the Club's program, who will inform the appropriate Club contact.
• Photographs in which my child appears have the chance to be used in Club marketing materials, promotions, recognition, displays, and other Club-related publicity. In addition, the Club can upload all photographs and videos in which my child may appear on official BGCGM social media sites and websites.
• Members whose parents/guardians give permission to attend a Club field trip, consent to their child potentially having their photograph/video taken by the host of the field trip during the activity.
• My child will have the opportunity to complete Club surveys used to measure the effectiveness of the Club program.
• I realize my child/children may participate in activities and programs that are physical and, as a result, may be at risk for injury. In consideration for being allowed to participate in any activities, I agree to assume such risk and further agree to hold harmless BGCGM, its staff, and volunteers from any claims, suits, losses, or related causes of actions for damages including, but not limited to, such claims that may result from injury or death, accidental or otherwise, during, or arising in any way from the participation in the activities of the program.
• The Club Tax ID is on receipts given at the time of payment, or you can access information in your Procare account. Year-end tax statements are not provided but can be found in your Procare account.
• For member security and safety, individuals in our facilities and riding in our vehicles may be under video surveillance.
• Grade K-Grade 5 members are not allowed to use their internet-capable devices while at the Club, and grade 6-12 members are permitted under staff supervision. All members using a Club internet-capable device will only be allowed under staff supervision and is subject to site filtering.
• Continued membership to BGCGM is determined based on the child’s behavior and the behavior of the parent/guardian.
• If I need to withdraw my child from a program, a two-week written notice is required.
• The membership fee is non-refundable.

School Program Payments: All weekly fees are due on Friday for school program payments. If payments are late, a $10 late fee will be added to your account. If you are late three times you will be required to enroll in autopay with a valid checking/savings account or credit/debit card. If autopay is declined twice, your only option to remain in the program is to pre-pay the fees for the remainder of the year. If you miss your payment two weeks in a row, we will remove your child/children from our program. Payments can be made through your account at myprocare.com, in person, or by calling the office.

Summer Program Payments: All weekly fees are due on Monday for summer program payments. If payments are late, a $10 late fee will be added to your account. If your payment and late fee are not paid by the end of day on Wednesday, your deposit will be forfeited, and your spot will not be held. Payments can be made through your account at myprocare.com, in person, or by calling the office.

Please direct any questions regarding your account to Kim Kuehl, Office Manager, at 625-5982 x225 or kkuehl@bgcgm.org

Please select an option for all 10 weeks. If you have been notified that your child(ren) is receiving financial assistance, your weekly amount will be different than those listed below.

• Summer program is $210 a week. Each week paid in full, at the time of registration, will receive a $10 discount. This discount does not apply to members who are receiving financial assistance.
• *Week 2 is a 4-day week, due to the holiday. This week is $165.
• A $25 deposit is due at the time of registration for each week requested that is not paid in full to hold your spot. The balance of that week is due by the date above, and on your receipt.

I hereby give my permission for medical treatment deemed necessary by physicians designated by the BGCGM authorities and/or transportation to a hospital emergency room for treatment for any illness or injury resulting from their participation in the summer program

I understand this authorization will only occur if I cannot be contacted and provide immediate treatment. As the individual responsible for payments, I have read, understand, and agree to abide by these policies and procedures set forth by BGCGM.