Register for BVO's Kids Club

Parent Contact Information

Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!

Please click on the plus sign to add other parent's information.

Emergency Contact Information:

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Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!

To whom may this child be released?

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Field is required!
Field is required!
Field is required!
Field is required!

Child Information

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Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!

**Required for school based programs

Child's Medical Information

Child's Family Physician:
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Field is required!
Field is required!
Field is required!
Field is required!

Child's previous history of communicable diseases:

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Field is required!

Symptoms of child's ill health: (indicate child's usual reaction to illness e.g. high temperature, flushing, vomiting, irritability, etc.)

Field is required!
Field is required!

Special requirements for diet, rest or exercise: (written and signed instructions must be provided by a parent of the child)

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Field is required!

Special Medical Conditions:

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Field is required!

Medical treatment: drug or medication to be administered during the hours the child is receiving care (written and signed instructions must be provided by a parent of the child)

Field is required!
Field is required!

Child's allergies:

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Field is required!

Please comment on your child's development, giving information that will be useful in the provision of care (e.g. child's habits, favourite activities, routines, fears, etc.)

Field is required!
Field is required!

Trip Consent

As part of our Day Camp and Kids club Programs, the children will have opportunities to visit places of interest in the community. (ex. LE Shore Library, short walks, Local parks) We will walk or ride our bikes. (bike rides for Daycamp partipants only)
  • Please note this is not for Daycamp planned bus trips there is a separate consent that you will fill out at the program site.
  • Please note this is not for planned PA Day, or Early Dismissal day trips-there is a separate consent for those trips that you will fill out at the program site.

I permit my child to go on trips planned and supervised by BVO staff.

Field is required!
Field is required!

Photo Consent

I am aware that my child may be photographed or videotaped while attending a BVO program or while on an outing associated with a BVO program. I further understand that these pictures may be used for public relation purposes or teaching purposes.

Field is required!
Field is required!

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