After School/ Summer Program : Youth : Our Programs : Bent County Community Center

202425 After School Program Registration

Welcome to the Bent County After School Program (ASP) registration page! We are excited to have you join the program and we look forward to another successful year. Do to rising costs and decreased budgets we have decided to charge fee per student for each month. The fees will be used to offset the costs or food, staffing, materials, and other general expenses associated with the BC ASP. To help you better understand the costs associated with the ASP we want to share some general financial information.

ASP Staffing Costs annually (min): 2 part-time staff =$21,000.00
Cost for snacks and food annually= $5,000.00
Costs for materials (STEM, books, sports equipment, art/crafts, etc.) = $2,500.00
Costs for general operating supplies=$1,000.00

2024 BCSP activities plan (click to view)

Student

Student Name

First Name *

Last Name *

Birth date

(all 4 numbers for the year)

Month

Day

Year

Select Current Grade (2024-25) (Required)

Current Grade

Select Registration Period

Semester 1 (Sept 2024-Dec 2024)
Semester 1 & 2 (Sept 2024-May 2025)

Parent Name ( Guardian )

Parent

First Name *

Last Name *

Address

Date

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Parent Phone # (Required)

Parent Phone #

jjl8d0ya6h5d

(Required)

Parent Email (required)

Emergency Contact #1

Emergency #1

First Name *

Last Name *

Emergency #1 Phone (Required)

Emergency #1 Phone

WILL YOU ALLOW YOUR CHILD TO WALK HOME FROM THE PROGRAM?

(MUST BE IN 4TH GRADE OR ABOVE TO LEAVE THE BCSP ALONE)

Yes . I WILL allow my child to walk home alone.
NO. I WILL NOT allow my child to walk home alone.

NOTE: THIS SECTION MUST BE COMPLETED

Medical and Allergy information

Please Note any allergies, medical info, or information.

General Comments:

Parent(s) or Guardian(s) who have been authorized by this form are the only persons staff will release the child to from the ASP( After School Program). If there is an emergency that prohibits those authorized on this form to pick up the child, we require the parent to call the Bent County Community Center front desk at 719-662-1235 to advise staff of the person receiving “one time” authorization to pick up the child. To maintain a safe process for your child we ask that this procedure only used in case of emergency.

(WAIVER OF LIABILITY & APPROVAL FOR PARTICIPATION)

In consideration of (name of child)membership and participation in the activities, special program or events at the Bent County/Las Animas Community Center, I as parent/guardian of above named minor, grant permission for participation in center activities and waives any and all rights and claims or damages against the Bent County/Las Animas Community Center and/or its sponsors for all claims arising from traveling to center and participating in activities and programs. I will on behalf of above said child assume and pay any medical or emergency expenses in the event of an accident, illness, or other incapacity. I authorize the ASP to share information with the Las Animas school district, and to take pictures of my child participating in ASP activities.

(Required)

PLEASE READ THIS LIABILTY FORM TO SUBMIT FORM

I hereby release and absolve the Bent Count Recreation League, the City of Las Animas, Bent County and all its employees or agents of same from any claims arising from injury received by the participant involved in this activity, whether due to negligent acts or omissions of said parties, other participants or otherwise. In case of accident or illness, I hereby authorize a representative of the BCRL to use his/her judgment in obtaining immediate medical care. I understand that some teams may travel to other towns for games and/or tournaments. I understand that it is my responsibility to provide or arrange transportation for my child(ren) to out of town games.  Participant Obligations: As with any extracurricular activities, education comes first.  All participants must attend a full day of school before participating in any BCRL organized event.      By signing below as parents/guardians/participants, you agree to the above conditions as listed on this form. Failure to comply may result in any or all of the following: suspension of participation in upcoming events, dismissal from the team, or the participant and or family no longer permitted to participate in BCRL sponsored events.  General Participant Waiver Acknowledgement and Waiver of Liability City of Las Animas, Las Animas School District, Bent County and  Bent County Recreation League  Event/Activity:  Bent County Youth Football As a participant in the above named event or activity, I am doing so at my sole risk.  Insurance coverage of any type is not provided by the county, its Board of County commissioners, appointed boards, its employees, its agents or its assigns, regarding any injury, loss of liability that may arise through the participation in this activity. I fully understand and agree that if I use any of my personal property while participating in this event or activity, the county will not provide insurance coverage or be financially responsible should damage or loss occur. By signing this Acknowledgement and Waiver of Liability, I agree to abide by all rules and regulations pertaining to this activity.  I further agree and understand that the county is not responsible for my actions and I release and absolve the county from any liability associated with this event.

Parent /Guardian Name

First Name *

Last Name *

BY SUBMITTING YOU AGREE TO THE TERMS AND LIABILTY WAIVER