GAMESROOM AND BUS PASS APPLICATION- 2010-2011

Last Name: First Name: Gender: ____

Address: Town: Zip: Telephone:

DOB: School: Grade: ____

Please Note: You must have a current Boys & Girls Club membership in order to purchase a Senior Gamesroom, and/or Bus Pass.

ü Check as many as required.

q ANNUAL MEMBERSHIP (Please complete attached form) $35.00

Grades K-12 (Valid to May 31, 2011)

q SENIOR GAMESROOM PASS (September 7, 2010 thru December 23,2010) $25.00

Grades 6 - 12 ONLY

(Valid Monday through Thursday, from 3:00 p.m. to 6:30 p.m., and Friday,

from 3:00 p.m. to 9:00 p.m. and coinciding with the school calendar.)

q BUS PASS (Vernon School) (September 7, 2010 thru December 23, 2010) $53.00

Grade 6

Senior Gamesroom pass holders.

q BUS PASS (Oyster Bay High School) (September 7, 2010 thru December 23, 2010) $53.00

Grades 7 - 12 ONLY

Senior Gamesroom pass holders.

TOTAL $

Transportation Information:

§ The bus pass is valid from September 7, 2010 – December 23, 2010.

§ There are absolutely no refunds for absences, changes, withdrawals, or terminations.

§ The bus pass is non-transferable.

§ Your child MUST have a bus pass to board the bus to and from the Boys & Girls Club on a daily basis. There are NO EXCEPTIONS to this rule. Therefore, it is strongly suggested that you secure your child’s pass to his or her book bag.

§ If your child loses his/her bus pass, inform the Club immediately and arrange a time to pick up a temporary card until the replacement card is available. The fee for a replacement card is $5.00.

§ The Boys & Girls Club of Oyster Bay-East Norwich cannot assume responsibility for any youngster who misses the bus.

Behavior Expectations:

To maintain a constructive atmosphere and for safety purposes, the Boys & Girls Club of Oyster Bay-East Norwich must establish rules for riding the bus. Consistent behavior problems on the bus will result in a conference being held with the Director, parent/guardian and child to review the Club rules and to discuss possible solutions. In extreme circumstances, including serious discipline problems, transportation privileges may be revoked. After a conference with parents and the child, the child may, at the sole discretion of the Director, be withdrawn from the program and/or requested to relinquish his/her bus pass, without a refund of tuition.

Rules for Riding the Bus:

§ When boarding or exiting the bus, children are to cross in front of bus.

§ Wait until the bus comes to a full stop before attempting to board or exit.

§ After boarding the bus, go directly to a seat and remain there until the bus comes to a complete stop.

§ Follow the same rules of conduct and speech that you are expected to follow in school and at the Boys & Girls Club.

§ Don’t eat, drink or smoke on the bus.

§ Keep feet and sharp objects off seats at all times.

§ Keep the bus clean. Do not litter or be destructive.

§ Keep your head, hands, and feet inside the bus.

§ Refrain from talking to the driver while the bus is in motion.

§ Understand that the driver is the adult in charge on the bus.

§ No person other than a Boys & Girls Club member, staff person, or other individual designated to supervise the youngsters shall be permitted on the bus.

Parent/Guardian Signature: Date:

All registrations must be paid in full and checks are to be made payable to the:

Boys & Girls Club of Oyster Bay-East Norwich.

Registration is currently in progress and is on a first-come, first-serve basis. There are no refunds for absences, changes, withdrawals, or termination. The Club reserves the right to cancel classes or events with insufficient enrollment and to modify programs, as necessary. You must be a Boys & Girls Club member in order to participate in any Club activities or programs. For more information, call Valerie Buscemi Program/Outreach Director at (516) 922-9285, ext. 19., or visit our website at www.bgcoben.org. Visit us on Facebook and become a fan. This program is not officially endorsed by the Oyster Bay-East Norwich Central School District.