Member 1 Name*
First
Last
Date of Birth* List anyone not allowed to pick up child by court order A document is needed if there are any custody orders involving restrictions or limitations of when any parent or guardian is allowed to drop off or pick up.
Site Information Select at least one option from the list below.
Summer 2025 Morning and afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
School Year 2025-2026 Morning snack will be served.
Day(s) Attending*
School Year 2025-2026 Morning snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
School Year 2024-2025 Morning snack will be served.
Day(s) Attending*
School Year 2024-2025 Afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
The questions below are designed to help us understand and work effectively with your child. You are not required to answer these questions; however, the lack of this information may affect our ability to work with your child.
Describe any unusual health conditions of the child:
This question is designed to help us understand and work effectively with your child. You are not required to answer these questions: however, the lack of this information may affect our ability to work with your child.
Note: If you answered yes to either of the above two questions, an intake questionnaire will be provided for you, to detail your child's specific needs to insure success for your child.
I give permission to the staff at BGC/KIDSTOP to apply sunscreen during programming.* Immunization Information* I understand I am responsible for submitting the following:
Policy changes at the Minnesota Immunization Information Connection (MIIC) no longer allow Boys & Girls Clubs of Central Minnesota to pull immunization records directly from their site. Therefore, we must require parents to provide a current copy of each registered member's current immunization records, per certification requirements. We must receive current immunization records before your child’s start date at KIDSTOP. Email them to
immunization@bgcmn.org as soon as possible.
Member 2 Name*
First
Last
Date of Birth* List anyone not allowed to pick up child by court order A document is needed if there are any custody orders involving restrictions or limitations of when any parent or guardian is allowed to drop off or pick up.
Site Information Select at least one option from the list below.
Summer 2025 Morning and afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
School Year 2025-2026 Morning snack will be served.
Day(s) Attending*
School Year 2025-2026 Afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
School Year 2024-2025 Morning snack will be served.
Day(s) Attending*
School Year 2024-2025 Afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
The questions below are designed to help us understand and work effectively with your child. You are not required to answer these questions; however, the lack of this information may affect our ability to work with your child.
Describe any unusual health related conditions of the child
This question is designed to help us understand and work effectively with your child. You are not required to answer these questions: however, the lack of this information may affect our ability to work with your child.
Note: If you answered yes to either of the above two questions, an intake questionnaire will be provided for you, to detail your child's specific needs to insure success for your child.
I give permission to the staff at BGC/KIDSTOP to apply sunscreen during programming.* Immunization Information* I understand I am responsible for submitting the following:
Policy changes at the Minnesota Immunization Information Connection (MIIC) no longer allow Boys & Girls Clubs of Central Minnesota to pull immunization records directly from their site. Therefore, we must require parents to provide a current copy of each registered member's current immunization records, per certification requirements. We must receive current immunization records before your child’s start date at KIDSTOP. Email them to
immunization@bgcmn.org as soon as possible.
Member 3 Name*
First
Last
Date of Birth* List anyone not allowed to pick up child by court order A document is needed if there are any custody orders involving restrictions or limitations of when any parent or guardian is allowed to drop off or pick up.
Site Information Select at least one option from the list below.
Summer 2025 Morning and afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
School Year 2025-2026 Morning snack will be served.
Day(s) Attending*
School Year 2025-2026 Afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
School Year 2024-2025 Morning snack will be served.
Day(s) Attending*
School Year 2024-2025 Afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
The questions below are designed to help us understand and work effectively with your child. You are not required to answer these questions; however, the lack of this information may affect our ability to work with your child.
Describe any unusual health related conditions of the child
This question is designed to help us understand and work effectively with your child. You are not required to answer these questions: however, the lack of this information may affect our ability to work with your child.
Note: If you answered yes to either of the above two questions, an intake questionnaire will be provided for you, to detail your child's specific needs to insure success for your child.
I give permission to the staff at BGC/KIDSTOP to apply sunscreen during programming.* Immunization Information* I understand I am responsible for submitting the following:
Policy changes at the Minnesota Immunization Information Connection (MIIC) no longer allow Boys & Girls Clubs of Central Minnesota to pull immunization records directly from their site. Therefore, we must require parents to provide a current copy of each registered member's current immunization records, per certification requirements. We must receive current immunization records before your child’s start date at KIDSTOP. Email them to
immunization@bgcmn.org as soon as possible.
Member 4 Name*
First
Last
Date of Birth* List anyone not allowed to pick up child by court order A document is needed if there are any custody orders involving restrictions or limitations of when any parent or guardian is allowed to drop off or pick up.
Site Information Select at least one option from the list below.
Summer 2025 Morning and afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
School Year 2025-2026 Morning snack will be served.
Day(s) Attending*
School Year 2025-2026 Afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
School Year 2024-2025 Morning snack will be served.
Day(s) Attending*
School Year 2024-2025 Afternoon snack will be served.
Please select a fixed or a customized schedule for your child* Day(s) Attending*
The questions below are designed to help us understand and work effectively with your child. You are not required to answer these questions; however, the lack of this information may affect our ability to work with your child.
Describe any unusual health related conditions of the child
This question is designed to help us understand and work effectively with your child. You are not required to answer these questions: however, the lack of this information may affect our ability to work with your child.
Note: If you answered yes to either of the above two questions, an intake questionnaire will be provided for you, to detail your child's specific needs to insure success for your child.
I give permission to the staff at BGC/KIDSTOP to apply sunscreen during programming.* Immunization Information* I understand I am responsible for submitting the following:
Policy changes at the Minnesota Immunization Information Connection (MIIC) no longer allow Boys & Girls Clubs of Central Minnesota to pull immunization records directly from their site. Therefore, we must require parents to provide a current copy of each registered member's current immunization records, per certification requirements. We must receive current immunization records before your child’s start date at KIDSTOP. Email them to
immunization@bgcmn.org as soon as possible.
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