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PLEASE JOIN US FOR OUR FIRST JOL DAY CAMP RUN IN PARTNE GIRLS CLUB AND SUMMER {IP WITH THE BOYS AND WN OF ST PAUL . ; e Da | Summer Day Camps EARLY BIRD REGISTRATION BEGINS MAY 23RD! WEEK LONG REGISTRATIONS ONL’ INGLE AY REGISTRATION BEGINS JUNE 15. RE AQUATIC C TRATION AVAIL! NTRE ORAT THE 780-645 EAT THE ST PAUL. JOYS AND GIRLS CLUB 188 OR 480-645-6769 Lunch program, field trips, sw ning lessons, tennis lessons, science experiments, crafts, games And much more q $175 per week or $40 per day. Ava starting on July grd. Subsidies are able every week of the summer wailable for qualifying families. SA a4 Town of St, Paul Town of St Paul and The Boys & Girls Club St. Paul Curling Rink Lounge Community Summer Program Welcome to our first official community summer program! Thank you for choosing to enroll your child in our program. You can expect your child to take part in many events/activities filled with wonderful opportunities and fun, safe, friendly experiences! We area licensed, accredited and inclusive program. If you require funding or subsidies to help you with the cost of the program, please contact Sylvie to book an appointment to go over your options. We are open for operation: June 28"'- September 1", 2017 Hours of Operations: Monday - Friday 7:30AM- 6:00PM Drop off cut off time: 9:30 AM (all programs have begun) Weekly Fee: $175.00 Daily Fee: $40.00 Registration fee: $30 For further questions, please contact: © Rob at (780) 645 — 3388; rsimons@town.stpaul.ab.ca ¢ Amber or Tracy at (780)645-6769; bgclubstpaul.ab@hotmail.ca © Sylvie at (780) 645 - 6769; sylvie.bgclubstpaul@hotmail.ca Subsidies & Canadian Jumpstart Funding applications available. Dear Parents/ Guardians: During the summer program we ask that parents/guardians provide their child(ren) with the following supplies that should be kept in their personal back pack to ensure that they are having as much fun as possible. Please supply: Back pack Water bottle Change of clothes (in a plastic zip lock bag) Swim suit Towel Sandals and running shoes Hat . Sun block or Bug Spray (your choice as to which one) . Sunglasses (optional) 10. Snacks (with healthy choices from the Canada Food Guide) PRErnanawnr- Please pay close attention to our calendar for scheduled swimming and picnics dates to ensure your child has everything he/she needs! *Please note that we are a nut free zone* **Please remember to label all your child’s items/ belongings* ***Please know we choose healthy snacks most often*** The Boys Girls Club/The Town Of St Paul ‘St Paul Curling Rink Lounge Summer Program Child's Name: pos: Home Address: SURREY Sa A TE ‘Mother's Name: Father's Name: Guardian #1 Name: Guardian #2 Name Land/Street Location: Land/StreetLocation: Mailing Address: Mailing Address: Town/Province: Town/Province: Postal Code: Postal Code: Phone #: Phone #: elt #: cel: E-mail edéress: E-mail address: Werk/ School Phone Werk/ School Phone #: Emergency Contact #1: Emergency Contact #2: (tb oar hn pre / garter 8 The BP Com) (ir ether thn pret gran mT Pad Camp Home Adaress Home Adgress: Phone: Phone: cuit: cet: Work/School Phone #: Work/Schoo! Phone #: ‘Medical Condition: Yes/No State Medical Condition: List of Medication: How is medication to administer: Allergies Yes/No List of Allergies: Allergy Reactions Emergency actions: ‘Immunizations up to date: Yes/No Explaination(Optional): Emergency/Medical Waiver: I give permission to the Summer Program Staff to give emergency medical care to the event that I cannot be contacted immediately. I further consent to pay for all medical expenses deemed necessary in such an emergency. Parent/Guardian Signature: Date: Health History Created by Syve roteou May 12,2017 Updated by Amber Cobiere The Boys Girls Club/The Town Of St Paul What are your child's reactions to illness:(convulsions to high fever etc.) Food likes: Food dislikes: Is your child a fussy eater: Sleeping Habits Does your child nap? Yes/No ‘Any other relevant information: Toileting Habits Is your child toilet trained? Yes/No ‘Any other relevant information? Note: Parents are required to supply diapers, pull ups, ad wipes for those children who use them. ‘Also, please supply extra clothing and underwear at all times, Thank you! Photo Waiver I give permission to the Summer Program staff to take pictures of my child while attending the centre and centre functions. These pictures may be displayed in photo albums and décor, newsletters, facebook and The Town of St Paul or Boys and Girls club marketing, Parent/guardian signature: Date: Field Trip Permission Waiver Thereby give consent for my child to leave the premises of the Summer Program on walking excursions to places of interest planned and supervised by the staff of the Summer Program. I understand the children visit businesses in St.Paul as well as neighbourhood Parent/guardian signature: Date Contracted time agreement: (maximum of 9.5 hours per day) T understand that I must have my child picked up no later than my contracted time. T also Understand that 9.5 hours per day is the maximum of hours I am entitled to, If Iam late with no notice, I will be charged $5.00 for every 15 minutes that I am late. Parent/guardian signature: Date: Volunteer Always looking for volunteers: Please circle one (field trips, bingo, special occasions). Yes/No What is the best way to reach you (Please circle one) Text Call ~— Email Facebook ‘Swimming Lessons Created by sive roteau May 42.2017, Updated by Amber Corbiere The Boys Girls Club/The Town Of St Paul Has your child/ren had swimming lessons before. Yes/No If yes what level Zumba Lessons Has your child participated in zumba lessons before. Yes/No ‘Subsidy Do you need financial assistance with childcare subsidy: Yes/No Would you like to book an appointment? Tf Yes what day: Time Have you applied for subsidy Yes/No Do/will you recive subsidy? Yes/No If yes what is the amount: Getting to know your child: Has your child been cared for by anyone other than a family member: Yes/No What is your childs first spoken language: Does your child have siblings Yes/No Tf yes please list names: How well does your child settle in new surroundings? Does your child have any particular fears or dislikes? Does your child have any comfort item? (blanket, toy?) ‘Are there any customs or religious beliefs that would prevent your child from participating in any holiday or seasonal occasions? Tell us a little bit about your family (culture,traditions living with family such as grandparents ect) What is your family nationality? What is your family heritage? Dietary Does your child have any dietary restriction due to customs or religious beliefs: Yes/No Tf yes,what is the restrictions: Your child's daily information What date will your child start coming to the club? What time would your child arrive? ieron Usted yer Cr The Boys Girls Club/The Town Of St Paul What time will your child be picked up? Contracted hours What days during the week would your child need the Summer Program services? (Please enter hours required per day.) [Eeea} Ee | Fomiles are entitled to a maximum of 915 hours a day for full time fees, There isan extra charge for exceeding the maximum daily hours T have read and understani Parent/Guardian Initials Who is has permission to pick up your child from the Summer Program? (They require photo id when they do so.) Name Relationship Yo the child Porent/Guardian Initials Is there anyone who is absolutely NOT allowed to pick-up or have access to your child? Name Relationship to the child Parent/Guardian Tnitials T have read and filled out this registration form completely and truthfully to the best of my knowledge. Parent/ Guardian signature: Date: Thank you for choosing Community Summer Program . We look forward to our days with your child! Created by Sy Proteau LIRR elebe Updated by Amber Corbiere SATURDAY CLOSED QEPC DAY 30 woring: Little Afternoon: Splash Afternoon: Field Trip, | ParkiMovie, Craft, Craft, Sports Sports Basketba Theme 5 crosep QEPC DAY Morning: Little Chef's, Science, Swim /Afternoon: Craft and ‘Morning: Little Chef's, Science, Swim Morning: Little Chef's, Science, Swim ‘Afternoon: Craft and Sports 4 ‘Morning: Little Chef's, Science, Swim Afternoon: Tennis, Craft, Sports 41 ‘Morning: Little Chef's, Science, Swim Afternoon: Tennis, Craft, Sports 18 Morning: Little Che?s, Science, Swim Afternoon: Tennis, Craft, Sports Science, Swim Afternoon: Tennis, Craft, Sports 5 ‘Morning: Little Chet Science, Swim Afternoon: Library, 12 ‘Morning: Little Chef's, Science, Swim ‘Afternoon: Library, Craft, Sports, Zumba 19 Morning: Little Che? Science, Swim /Afternoon: Library, Craft, Sports, Zumba Morning: Little Chef's, Science, Swim /Afternoon: Library, (Craft, Sports, Zumba Science, Swim Afternoon: Field Trip, Craft, Sports Little chef's, Science, Swim ‘Afternoon: Field 7 Graft, Sports Morning: Little Chefs, Science, Swim Afternoon: Field 7 Craft, Sports 27 Morning: Little Chef's, Science, Swim Afternoon: Fis Craft. Sports "| Afterno Jz. Morning: Lite Tents, science, 5 Afternoon: Splash 141.4 Morning: Little Chef's, Science, Swim splash Park/Movie, Craft, Sports 124 Morning: Little Afternos Park/Movie, Craft, Sports 128 moming: title he's Science Swim Afternoon: Splash Pa Movie, Craft, Sports SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY meade Theme isl ® Science, Swim ‘Afternoon: Tennis, Craft, Sports CLOSED QEPC DAY Morning: Little Chef's, Science, Swim Afternoon: Tennis, Craft, Sports ‘Morning: Little Chef's Science, Swim ‘Afternoon: Craft and Sports 415 Morning} Science, Swim ‘Afternoon: Tennis, Craft, Sports 22 Morning: Little Chef's, Science, Swim Afternoon: Tennis, Craft, Sports Science, Swim Afternoon: Craftand 29 Morning: Little Chef's, Science, Swim ‘Afternoon: Tennis, Craft, Sports ‘Morning: Science, Swim ‘Afternoon: Craft and Sports Little Chefs, Science, Swim ‘Afternoon: Field Trip, Craft, Sports jorning: Little Chefs, Science, Swim sfternoon: Library, raft, Sports, Zumba [Morning: Little Chef's, IScience, Swim ‘Afternoon: Field Trip, Craft, Sports Chefs, Science, Swim ‘Afternoon: Field Trip, Craft, Sports Chef's, Swim Afternoon: Field Trip, Craft, Sports IMorning: Little Chef's, ‘cence, Swim ternoon: Library, raft, Sports, Zumba | Trip, Craft, Sports SUMMER PROGRAM ey FRIDAY SATURDAY Ss Chef's, Science, Swim fternoon: Splash ParkyMovie, Craft, ah v Jumpstart a te APPLICATION FORM : SECTION APPLICATION NFORUATION Chasen 3 Benbow (atm mae aes | oy. Tee SECTION 2: REQUEST FOR FUNDING Peaseidenty he spoteracityorwrcnyousrereqsinghedng, Ete: (garzaton feng he sorter acy Smtbae ed ate: fofSewors: _Lerhofsessionrmintesy plratono Feet: at Pease indicate amaut you we aie cent 3 Pease ndcae ype ol ess requested tm Jung Oranzaten cont Eta: ass: ProincTenioy Ce: ‘SECTION 5: ENDORSEMENT Conmanty eater (Soa PrncpalGudarce CanslrDaterDanst aye) Nae: oy = Proves Teepe ( mat 2 = e Pete dicate atone apart |centy my enersementf he stove cout and vey ae inloran pen caret a an siete Sonate = Date _ s "posse eae atoch ater am a commun leaerincaing eltonsip 0 aplcant ern he apa cao bar patil nthe rusted ‘actor program. The coment adr rel bem a poston erty an assess he ecoumc bane beapplant Please forward completed applications to Sylvie Proteau @ ‘The Boys & Girls Gib of St. Poul & District Bex 1009 4821 50 Ave ‘St Paul, Alberta ‘TOA 340 Please contact me if you have any questions in regards to the Junpstart Program © 780-645-6769 ‘natn Tee Jungs ans meres wiespet he conetlly of al appar. 8y cole he apa, ney auotee Canadian Te Jungs ard 1 Chap meer contac me consult wih corsa ard Sars hs mcman wth be rena corpany at wl tee be pay hy os ‘AMinfomaon cape above a reqteent of arn Te Lumps ands abit lca pat oe eqenert ering person iematons seed ad protected an ote wed xy cer use oer an rnc heh proved stan, 2011 Page 1 May 16, 2017 Dear Parents/Guardians, To improve consistent weekly billing, as well as to ensure appropriate levels of staffing, we are asking parents to complete the attached blank calendars for the following month indicating which days their children will be accessing services. Please mark the dates of program services that your child will be attending with his or her name. If you have more than one child, enter all the children’s names in the appropriate dates. Also, due to staffing requirements it is necessary to bind all dates booked on these calendars to an agreement. There is no discounts or transfer of funds for days missed. There is no proration of absent or days missed unless due to expected or unexpected closures. If you have any other questions about this practice, please be sure to contact Rob or Sylvie. Families are responsible for payment of booked days prior to the first day of program services. Again, this practice is to ensure that there is adequate staffing and adequate funding to pay staffing wages in place to accommodate the children attending the program. © Rob at (780) 645 — 3388; rsimons@town.stpaul.ab.ca © Sylvie at (780) 645 - 6769; sylvie.bgclubstpaul@hotmail.ca The Summer Program agreement: Cancellation: User withdrawal from a Program is subject to a cancellation administrative fee of $5.00 per person per program. User withdrawal from a Program after a Program has started, or with less than 72 hours prior to the first class, will only be permitted with written confirmation of a medical condition or residence relocation that prevents participation in the Program’s activities. Any such cancellation refunds will be pro-rated. ‘Maximum daily hours of services: Each family is entitled to 9.5 hours of services a day. If a child attended hours exceed the 9.5 hours a day, the family will be responsible for additional costs of $5.00 per 15 minute until child is picked up. The additional costs are to cover to employee's (min of 2 employees) overtime expenses. Exception: From time to time, there are exceptions to be made. If you require more than 9.5 hrs of services a day, please contact Rob or Sylvie to request an extension of hours to look at more options. Procedure: * Use the calendars provided. Please mark the dates of program services that your child will be attending with your his or her name. If you have more than one child, enter all the children’s names in the appropriate dates. © Sign and date below to verifying you understand that you are responsible for each day booked whether the child attends or not, (Fees are to cover the cost of staffing and we schedule accordingly.) © Place the filled calendar, signed contract and payment to ver the St. Paul Aquatic Center of The Boys and Girls Club. Guidelines: = Alldrop-in schedules will be approved on the first come first serve basis. WE will continue to book children in the program until full capacity of our program is met. ‘* We will notify you as soon as we can if the spaces are not available for your child. All fees and calendars due prior to services. (This can be paid weekly, or daily as well.) * Families receiving childcare subsidy are responsible to cover any childcare fees not covered by subsidy. This does include underutilized contracted child care hours. Full week registration has priority to daily/drop in registration. There is a $50 charge for any NSF cheques. There is no refund/pro rate/adjustment for booked and approved schedule spaces for absences. (Exception to this guideline is if staff shortages, and program closures.) By signing this document, | have read and understand: The procedure and guidelines above. am financially responsible for fees in each calendar day | have booked. No refund/pro-rating/adjustment of refund of booked schedule days for absences. This process is considered complete once signed. Name of parent or guardian (Print) ste iee Bs ts See Signature: Date: 2017 JUNE | SUN MON FRI SAT 1 2; 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 ie 9 "00 a ae 25 26 7, 28 29 30 last doy Bk School www. free-printable-calendar.com www. free-printable-calendar.com SUN | MON 20 7 JULY FRI SAT pe a ae 7 @ pas | lo fo it ha 73 rc # eee We Me 20 7 2 | es 34 2 wee eer ae FD | bo a | 2017 AUGUST 1 2 3 ‘4 5 SUN MO! SAT 6 7 Se HO a, ee (Soe ee i ap 0 he toe gr tenes oe a ag 5 ep wevew roe: printable-calendar.com Q O0 He Wee BATOMIC Instructor RIGHTS, READ IT CAREFULLY! jing in ZUMBATOMIC The following wais ofthis a centered into By sent not ty sue and other he 77 MB AMTOMIC fall elas, release from all Vabilt, assumption ofall risks an tehalf ofthe undcrsigne: forthe Each Item Below after Reading and Understanding Fach Item: H 1am the Parent Guardian of With dhe intent that tis was cr Student andar e ecu binding on myself and his waiter on bchalf of the Seu Student for all purpose: ity a Parent Guardian and *ZUMBATOMIC Activites” includes but is no linited to lessons, classes, traning. use f by the ZUMB ATOMIC Iastrustor. reosiled 4 Tam aware that there are inherent and significant dangers, havards and risks (*Rishs") associated with the participation in ZUMBATOMIC Activities. Tam aware that the Risks include but are not Fimited to injury feom physical contact wih other studenis instructors or equipment, performing a skill incorrectly, or potentially dangerous obstacles, conditions onthe floor o vicinity ofthe ZUMBATOMIC Activides. T undetstand that the Risks ave relaive to the Student's ta emotional), and to the asareness, care and skill with which the student conducts him or herselt resulting from the Student's pancipation in ZUMBATOMIC Activities. T agree that akhough the ZUMBATOMIC Instructor has taken steps to raduce the Risks and increase the safety of the ZUMBATOMIC Activtis, it is not posible for the ZUMBATOMIC. ites completely safe, T accept these Risks and agree tothe tems of this waiver even if the ZUMBATOMIC Instructor is found to be negligent or in treach of any duty of ears oF any obligation to the Si tadent’spanicipation in ZUMBATOMIC Activites acknowledge the Studcnt’s obligation to inform the ZUMBATOMIC Instructor ifthe Student feels any pain, discomfort, fatigue or any other symptoms the Student may suffer during or immediately after bis or her participation in ZUMBATOMIC Activitics. 1 ferstand tha the Suident may stop participating at any time, and has the right to immediately withdraw from any exercise or drill in ‘which the conduct of any party seems beyond the scope of taining, makes the Student uncomfortable or whisk the Student believes will be Farmfl to hie of her. 6 In addition to consideration given to the ZUMBATOMIC Instructor for the Stussnt's participation in ZUMBATOMIC Activities, 1 and my heirs, next of kis, executors, administrators and assigns, as well as the Student's heirs, next of hin, executors, administrators and assigns (Collectively our "Legal Representatives") agree: (2) to waive all claims that 1, the Student or our Legal Representathves have or may have in the fut ZUMBATOMIC Instructor, and (6) to release and forever discharge the ZUMBATOMIIC Instructor from all ability for all personal injury. death. property damage or loss resulting from the Student's participation in ZUMBATOMIC Activities dus to any eause, including but not limited to negligence (Lilure to use such cate as a reasonably prudent and careful person would use under similar circumstances), breach of any duty imposed by law, breach of contract or mistake or ertor in Judgment of the ZUMBATOMIC Instructor, 1 1 agree to te liable for and to hold harmless and indemnify the ZUMBATOMIC Instructor from all ations, proceedings, claims damages, costs demands including coun costs and costs on a Solicitor and own client ass, and liabilities of whatsoever mature or hind arising out of or in any way connected with the Studeat’s participation in ZUMBATOMIC Activitss 8 1 agree that this waiver and all terms contained with panicipating in ZUMBATOMIC Activities by the Laws ofthe Prosince or Tertitory ia which the Studs on of the courts ofthat Province or Terstory ars go iimesocably submit tothe juris 9. | confirm that I have had sufficient time to read and understand eas ffeely and voluntarily. 1 understand that this waiver is binding on mgself, term fn this waiver in its entirety, and hae agreed tot Student and our Legal Representatives lease Print Cle Swudent Name ‘ Parent Guardian Adress i Parent Guardian Name ZUMBATOMIC last 8 Signed this day of saat Parents/Guardians Zumba video permission form Tf (print) give permission to post a video of my child participating in the Summer Program’s Zumbatomics fitness program to Facebook. The video will be posted on the instructor, Lori-Anne Peters, Zumba Facebook page. Parent/Guardian Signature, Date:

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