*Please note that the above personal information is vital and necessary for our records and the funding that our organization receives. The answers you provide will be kept completely confidential. Your cooperation for providing this information is both appreciated and important.
Authorization for School Release
Educational Information Release
I authorize my child's school district to share all grade reports and all necessary documentation with the Boys & Girls Clubs of the Heartland (BGCPB) to enhance my child's education. I grant permission for BGCPB to communicate with my child's teachers, access and copy grade reports, and discuss strategies to support my child's academic success.
Media Release
I authorize BGCPB to photograph, videotape, or interview my child for Boys & Girls Clubs media purposes only.
Activities/Program Consent
I have been informed that BGCPB provides supervised athletic, recreational, educational, cultural, and guidance programs, I consent to my child's participation in all activities and all prevention programs (Journeys, Smart Girls, MO Kids, etc. conducted by BGCPB during membership. I understand that members may walk between buildings while at the club.
Field Trip Authorization
I give permission for BGCPB to transport my child off-site for field trips, excursions, and to other club locations. I understand I will be notified in advance of planned field trips.
Liability Release
In consideration of my child's participation in BGCPB activities, I release and discharge BGCPB, its agents, employees, commissioners, and officers from all claims, demands, actions, judgments, and executions which I may have against BGCPB for personal injuries to my child (known or unknown) and property damage arising from club activities. I also release from responsibility any person transporting my child to or from BGCPB-sponsored activities.
Medical Authorization
I understand I will be promptly notified in case of an emergency involving my child. If I cannot be reached to make necessary arrangements, or in a critical emergency requiring medical care, I authorize BGCPB to contact the physician or hospital of my choice.
Research Participation
I give permission for BGCPB to collect information via surveys, questionnaires, interviews, and focus groups from my child. I understand that BGCPB may share information about my child with Boys & Girls Clubs of America (BGCA) for research and program evaluation purposes. All information will be kept confidential, with results shared only in aggregate form without individual references.
Acknowledgment
I understand that BGCPB is not responsible for personal injury or lost or stolen property. I have received a copy of this facility's policies regarding admission, care, and discharge of children. The provider and I have agreed on a plan for continuing communications regarding my child's development, behavior, and individual needs. I understand that my child may not be accepted for care or remain in care when ill.
I have read this form, understand and agree to all its terms, and sign it voluntarily with full knowledge of its significance. I consent to my child participating in all activities as stated above and assume all risks.
Boys & Girls Club of the Heartland's 2025 Summer Learning Program
To enable all young people, especially those who need us the most, to reach their full potential as productive, caring, and responsible citizens.
Sign all forms, pay ALL delinquent charges, and pay the enrollment fee of $60.00 per child. (Enrollment fee covers the June After Summer Program or the first week your child is in our all-day camp program.) Your child's spot is not guaranteed until you receive a confirmation email from BGC Administration. Payment is not required until your spot is confirmed via email from BGC Administration.
Our 2025 June Summer Program starts on Wednesday, May 28th and ends on Wednesday, June 25th (after summer school - 5:30 p.m.). June 19th is a holiday. PB R-1 Summer School will not be in session, and BGC offices will be closed. Full Camp Days will begin on Thursday, June 26th and end on Friday, August 1st. Boys & Girls Club will be closed on July 3rd & 4th. Camp Day hours are 7:30 a.m. - 5:30 p.m. BGC will be closed to kids August 4th – 15th. JUNE All Day Summer Program for High School and out-of-district students is 7:30 a.m. - 5:30 p.m. Children MUST be dropped off no later than 9:00 a.m. Bus Transportation is provided for PBR-1 Summer School students ONLY.
Kids ages 6yrs - 18yrs can attend Boys & Girls Clubs of the Heartland. (Must have attended Kindergarten in the 24/25 School Year)
Enrolling parents/guardians will be charged $60.00 per week per child or a scholarship weekly fee during our summer program. When your child attends PBR-1 Summer School, there will be a charge of $15 per week per child. The parent who is signing the member up will be responsible for payments. Duplicate invoices will not be sent to joint custody parents. Payments are required by the last day of the week your child attends. If you are two weeks behind in payment, you will receive a phone call.
BGC offers programming in academic success, good character & leadership, and healthy lifestyles. Club members will be in groups for program and meals based on the grade they were enrolled in for the 24-25 school year.
We have several field trips planned for the 2025 Summer Program. Some of our field trips may require members to pay.
1306 Victory Lane is the primary drop-off and pick-up point for all members. (Please review the NEW pick up and drop off procedures) BGC is open from 7:30 a.m.-5:30 p.m. All kindergarten-5th grade members will be in the Annex for programming, and 6th – high school will be at the Teen Center, both located on the middle school campus. There is a charge of $1.00 per child for every minute after 5:30 p.m. your child is not picked up. After 30 minutes, BGCPB is required to call authorities. If your child misses 5 days or more, you will receive a phone call from Administration to discuss membership.
ALL members are required to attend the Summer School Program if available. Bus transportation will be provided to PBR-1 students only. All members MUST be transported by bus at all sites. Parent drop-offs are only accepted for PBR-1 High School, Junior High School, and out-of-district members. Any members wanting to attend BGC after summer school will be charged $15 per week per child.
BGC will offer breakfast, lunch, and snack to members. Breakfast will be served at 8:30 a.m. - 9:00 a.m. Lunch will be served from 12:00 p.m. - 12:30 p.m., and snack at 3:00 p.m. - 3:30 p.m. or when your child arrives after summer school. If your child has special dietary needs, please make sure it is listed on the medical form. If your child does not like what is on the menu, they may bring a sack lunch with them when dropped off. (Outside food will not be able to be brought to kids during club hours). ALL meals will be served in the classroom.
Parents must arrive at BGC between 7:30 a.m. – 9:00 a.m. Parents will not get out of their vehicle. At the end of the day, pick up is between 3:30 p.m. – 5:30 p.m. If a person is not listed on your child's membership forms as an authorized person to pick up your child, we cannot release your child to them. Please make sure to bring a photo ID the first few times you pick up a member. All parents must stay in their vehicles while waiting for their child. Please allow yourself at least 10 minutes for drop off and pick up.
*If your child leaves before the required pick-up time of 3:30 p.m., the child may not return to BGC that day.
Keeping your child safe is very important at Boys & Girls Club. Parents are not allowed anywhere in the Boys & Girls Club Facility. It is necessary to keep updated information on our club members and their parents. Please inform BGC front desk staff of any member information changes such as phone number, address, authorized pick up list, etc. BGC has an emergency preparedness plan stating that in the event of an emergency causing evacuation, we will transport your child to the softball field at Bacon Park. Do not send your child and/or siblings to club if they are sick or showing ANY of the following signs: Cough, Shortness of breath or difficulty breathing, sore throat, headache, fever, chills. BGC cannot store, dispense, or apply medicine. If your child requires medicine, a parent must come to administer the medicine. If your child has a temperature over 98.6, they will be isolated and parents will be notified. Once a child's temperature reaches 100 degrees, the child must be picked up immediately. Child may not return to BGC until they are 72hrs symptom and fever free without medication. In the event of an emergency, BGCPB will follow best practices per state licensing guidelines.
Do not allow your child to bring personal items to the club. BGC is not responsible for lost or stolen items; however, there is a lost and found area where lost items will be stored. Follow us on Facebook, LinkedIn, Remind 101, and visit bgcpb.org.
You will be notified via email if your child has been accepted into our program.
Out-of-District kids will be approved by May 23, 2025.
PB R-1 will be notified as soon as we receive the approved summer school list from PB R-1 School District.
