COVID-19 Qualifying Questionairre for our After-School Program - Smyrna Club

Dear Parent/Guardian,

Due to COVID-19, your Boys & Girls Club will be opening a modified non-traditional Club program. Because we will open in a limited capacity in order to maintain safe social distancing and keep members 6ft apart, we are only able to register a maximum of 90 children in all (40 Distance Learning and 50 after-school program). Because of this, we will have limited space designated for grade levels and/or schools. Members must qualify to participate and will be accepted on a first come/first serve basis.

Qualifications include:

Registration information will be emailed to members who qualify for our modified non-traditional program

Those who qualify will receive an email with registration information.

Our modified non-traditional after-school program is subject to change in the event of increased illness in our community.

*Each participating member is able to bring their own supplies, but may not share them with other Club members..

Was your child a member during the 2020 summer program or 2019-2020 after-school program?
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Please select the grade levels of your children. You may select all that apply.
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How many children do you intend to register?
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What are your children's name(s)?
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What school will your child be attending?
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Are you an Essential Worker? Please select from below.
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The $40 registration fee per child is due at the time of online registration.
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Is your child in one of the following programs? Verification is required.
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Our weekly fee of $40 per child will be required at least two (2) weeks in advance by NOON in order to maintain your child's spot (up to 2 weeks "vacation" is allowed without fees charges).
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If a child misses more than two consecutive weeks, or falls two weeks behind in payment, they may be placed on the waiting list and will not be able to attend until a spot opens back up.
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We require two (2) weeks notice, with payment, should a child exit our program.
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Additional criteria necessary to participate in our modified non-traditional after-school program includes all mentioned below. Please read and select each to verify understanding of requirements and expectations, and that your child can comply.
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What is your name? (Must be a custodial parent or legal guardian.)
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What is the best phone number to contact you?
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What is your email address? There will only be email communication should your family qualify for the after-school program.
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In the event that capacity is maximized would you like your child(ren) to be placed on a waiting list?
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Please provide any information you'd like to share with us (not required).

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