2025 BGCSE Enrollment Form

Program Enrollment
Attention! Parent(s)/Guardian(s) who wish to enroll a child(ren) in a Sioux Falls School District after-school or summer program, please complete the Sioux Falls School District (CLC) Family Informaion Form.
Thank you for your interest in the Boys & Girls Clubs of the Sioux Empire. The mission of our organization is to nurture, educate and enrich children and youth for lifelong success. We provide educational programming for children and youth ages 4 weeks to age 18 in Brandon, Harrisburg, and Sioux Falls.
- Early Learning Academy (ELA):
  - Infants/Toddler/Twos/Preschool & Pre-Kindergarten
  - Two Sioux Falls locations:
    
    Empower Campus (2001 E 8th St.)
    
    57th Street Campus (5015 S Crossing Pl., Ste 150)
- K-5 Enrichment:
  - Brandon: Brandon Elementary, Fred Assam, Inspiration, Robert Bennis, and Brandon Valley Intermediate School
  - Harrisburg: Adventure, Explorer, and Journey
  - Sioux Falls: Anne Sullivan, Eugene Field A+, Harvey Dunn, Laura B Anderson, Rosa Parks, Susan B Anthony, and Marcella LeBeau (open fall 2025). Please complete the Sioux Falls School District (CLC) Enrollment Form to enroll in one of the Sioux Falls sites.
- Teen Program:
  - Middle School & High School students
  - Two Sioux Falls Locations:
    
    Empower Campus (2001 E 8th St.)
    
    George McGovern Middle School (open fall 2025)
Please review the Boys & Girls Clubs of the Sioux Empire Tuition Rates document for details about program fees. Note that the teen program is offered at no cost.

To enroll a child(ren) in our Early Learning Academy, Brandon or Harrisburg K-5 Program, or the Teen Program, use the 'Enroll Now' button below to begin the enrollment process.

Child 1 Program Permissions
Mentoring Program
I give permission for Child 1 to participate in Boys & Girls Club of America Mentoring activities facilitated by the Boys & Girls Clubs of the Sioux Empire staff on-site during hours of operation. There are no additional costs for this program. Authorization can be changed at any time.*

YesNo
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Relationship to the child: *
Parent/Guardian Signature:*

Clear
Transportation
The Boys & Girls Clubs of the Sioux Empire (BGCSE) provides transportation before and after school for select programs and to and from field trips for all programs. BGCSE staff and each child or youth are responsible for safety, following all transportation rules, and behaving responsibly. Do you give permission for Child 1 to receive transportation and release the organization from any liability claims arising out of their engagement in the above transportation activities?*

YesNo
Parent/Guardian Signature:*

Clear
Photo Release
I permit the Boys & Girls Clubs of the Sioux Empire to use photos or videos of Child 1 for marketing and promotional purposes. Authorization can be updated at any time.*

YesNo
Authorization for Medical Treatment
I hereby authorize the Boys & Girls Club to arrange for medical treatment for Child 1 in the event of an emergency or if deemed necessary by a qualified medical professional. I understand that this may include, but is not limited to, first aid, emergency medical services, and hospital care.*

Yes
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Signature:*

Clear

School District Partnership:
I give permission for the release and exchange of educational information which may include grades, attendance, learning behaviors, test scores and other academic and behavioral information between the Boys & Girls Clubs of the Sioux Empire and Child 1's School District for the purposes of providing academic supports and enhancements (excludes Individual Education Plans or 504 forms).*

YesNo
Child 1 Full Name:*

First NameLast Name
Parent/Guardian Name:*

First NameLast Name
Relationship to Child 1:*
School District Student ID for Child 1:*
Parent/Guardian Signature:*

Clear

Child 2 Program Permissions
Mentoring Program
I give permission for Child 2 to participate in Boys & Girls Club of America Mentoring activities facilitated by the Boys & Girls Clubs of the Sioux Empire staff on-site during hours of operation. There are no additional costs for this program. Authorization can be changed at any time.*

YesNo
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Relationship to the Child 2: *
Parent/Guardian Signature:*

Clear
Transportation
The Boys & Girls Clubs of the Sioux Empire (BGCSE) provides transportation before and after school for select programs and to and from field trips for all programs. BGCSE staff and each child or youth are responsible for safety, following all transportation rules, and behaving responsibly. Do you give permission for Child 2 to receive transportation and release the organization from any liability claims arising out of their engagement in the above transportation activities?*

YesNo
Parent/Guardian Signature:*

Clear
Photo Release
I permit the Boys & Girls Clubs of the Sioux Empire to use photos or videos of Child 2 for marketing and promotional purposes. Authorization can be updated at any time.*

YesNo
Authorization for Medical Treatment
I hereby authorize the Boys & Girls Club to arrange for medical treatment for Child 2 in the event of an emergency or if deemed necessary by a qualified medical professional. I understand that this may include, but is not limited to, first aid, emergency medical services, and hospital care.*

Yes
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Signature*

Clear

School District Partnership:
I give permission for the release and exchange of educational information which may include grades, attendance, learning behaviors, test scores and other academic and behavioral information between the Boys & Girls Clubs of the Sioux Empire and Child 2's School District for the purposes of providing academic supports and enhancements (excludes Individual Education Plans or 504 forms).*

YesNo
Child 2 Full Name:*

First NameLast Name
Parent/Guardian Name:*

First NameLast Name
Relationship to Child 2:*
School District Student ID for Child 2:*
Parent/Guardian Signature:*

Clear

Child 3 Program Permissions
Mentoring Program
I give permission for Child 3 to participate in Boys & Girls Club of America Mentoring activities facilitated by the Boys & Girls Clubs of the Sioux Empire staff on-site during hours of operation. There are no additional costs for this program. Authorization can be changed at any time.*

YesNo
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Relationship to the Child 3: *
Parent/Guardian Signature:*

Clear
Transportation
The Boys & Girls Clubs of the Sioux Empire (BGCSE) provides transportation before and after school for select programs and to and from field trips for all programs. BGCSE staff and each child or youth are responsible for safety, following all transportation rules, and behaving responsibly. Do you give permission for Child 3 to receive transportation and release the organization from any liability claims arising out of their engagement in the above transportation activities?*

YesNo
Parent/Guardian Signature:*

Clear
Photo Release
I permit the Boys & Girls Clubs of the Sioux Empire to use photos or videos of Child 3 for marketing and promotional purposes. Authorization can be updated at any time.*

YesNo
Authorization for Medical Treatment
I hereby authorize the Boys & Girls Club to arrange for medical treatment for Child 3 in the event of an emergency or if deemed necessary by a qualified medical professional. I understand that this may include, but is not limited to, first aid, emergency medical services, and hospital care.*

Yes
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Signature:*

Clear

School District Partnership:
I give permission for the release and exchange of educational information which may include grades, attendance, learning behaviors, test scores and other academic and behavioral information between the Boys & Girls Clubs of the Sioux Empire and Child 3's School District for the purposes of providing academic supports and enhancements (excludes Individual Education Plans or 504 forms).*

YesNo
Child 3 Full Name:*

First NameLast Name
Parent/Guardian Name:*

First NameLast Name
Relationship to Child 3:*
School District Student ID for Child 3:*
Parent/Guardian Signature:*

Clear

Child 4 Program Permissions
Mentoring Program
I give permission for Child 4 to participate in Boys & Girls Club of America Mentoring activities facilitated by the Boys & Girls Clubs of the Sioux Empire staff on-site during hours of operation. There are no additional costs for this program. Authorization can be changed at any time.*

YesNo
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Relationship to the Child 4: *
Parent/Guardian Signature:*

Clear
Transportation
The Boys & Girls Clubs of the Sioux Empire (BGCSE) provides transportation before and after school for select programs and to and from field trips for all programs. BGCSE staff and each child or youth are responsible for safety, following all transportation rules, and behaving responsibly. Do you give permission for Child 4 to receive transportation.*

YesNo
Parent/Guardian Signature:*

Clear
Photo Release
I permit the Boys & Girls Clubs of the Sioux Empire to use photos or videos of Child 4 for marketing and promotional purposes. Authorization can be updated at any time.*

YesNo
Authorization for Medical Treatment
I hereby authorize the Boys & Girls Club to arrange for medical treatment for Child 4 in the event of an emergency or if deemed necessary by a qualified medical professional. I understand that this may include, but is not limited to, first aid, emergency medical services, and hospital care.*

Yes
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Signature:*

Clear

School District Partnership:
I give permission for the release and exchange of educational information which may include grades, attendance, learning behaviors, test scores and other academic and behavioral information between the Boys & Girls Clubs of the Sioux Empire and Child 4's School District for the purposes of providing academic supports and enhancements (excludes Individual Education Plans or 504 forms).*

YesNo
Child 4 Full Name:*

First NameLast Name
Parent/Guardian Name:*

First NameLast Name
Relationship to Child 4:*
School District Student ID for Child 4:*
Parent/Guardian Signature:*

Clear

Emergency Contacts

Two emergency contacts, other than parent/guardian(s), are required in case of an emergency if the parent/guardian(s) are unreachable.*

	First Name	Last Name	Primary Phone Number	Relationship to child(ren)
Emergency Contact 1
Emergency Contact 2

Authorized Pick-up Information

I authorize the following individual(s) to pick up the enrolled child(ren) beyond the listed parent/guardian(s) or Emergency Contacts above. Authorized individuals must provide a photo ID upon pickup.

	First Name	Last Name	Relationship to child(ren)
Authorized Pickup 1
Authorized Pickup 2
Authorized Pickup 3
Authorized Pickup 4
Authorized Pickup 5
Authorized Pickup 6

Is anyone restricted from picking up the child(ren)?*

YesNo
You selected 'Yes', please provide additional information, including the name of child(ren).:*

Enrollment Acknowledgements
Enrollment, Waitlist, and Technology Fees

Enrollment Fee for Early Learning Academy (4 weeks - 5 Years):
Upon enrollment, there is an enrollment fee of $50 per child or $100 per family. Additionally, an annual technology fee of $20 per child will be charged in January to support ongoing technology maintenance and upgrades within the organization.

Enrollment Fee for K-5 Programs (5 years – 12 years):
An annual fee of $40 per child or $80 per family applies.

Multi-Child Discount:
A multi-child discount of 10% will be applied to the oldest child(ren) enrolled with our organization.

Waitlist Policy:
If a program is full and you wish to be placed on the waitlist, all enrollment forms must be completed, and the registration fee must be paid.
Tuition Policy

Tuition rates vary based on the child's age and program. For detailed information, please refer to the Tuition Rate form.

Tuition is processed weekly on Tuesdays through Tuition Express via Electronic Funds Transfer (EFT) from the account provided during enrollment. Parents/guardians are responsible for paying the full tuition amount, regardless of attendance. Payment details can be updated at any time. A $15 return fee will be assessed on all payment declines (EFT and credit card declines) and a $60 fee for returned checks. Enrollment will be suspended if charges accumulate past two weeks of care and no payment plan has been established. Year-end tax statements will be provided upon request.

Parents/guardians acknowledge that, by enrolling in a program, they are financially responsible for the full tuition for the duration of the program, regardless of the child's attendance.

Children must be picked up by the program's designated closing time. If a child is not picked up on time, a late fee will be applied: $10 for the first 15 minutes and $5 for each additional 5 minutes, per child.

Staff at Boys & Girls Clubs of the Sioux Empire are eligible to receive a 65% childcare discount, with tuition processed through payroll.
Tuition Support

Childcare Assistance: Our organization accepts State Childcare Assistance. Eligible families are responsible for all co-pays and any fees that may accrue based on coverage. Any tuition fees not covered through the signed contract are the parent/guardian’s responsibility.

Boys & Girls Clubs of the Sioux Empire Tuition Scholarship: As a nonprofit organization, we offer scholarship support to qualifying families thanks to the generosity of the Sioux Empire United Way and other community donors. Scholarships are based on household size and income calculations determined by the State of South Dakota Child Care Assistance program to ensure that scholarships are applied fairly.
Would you like for a Family Engagement team member to reach out to you about Childcare Assistance or tuition scholarships?*

YesNo
Family Handbook

Parents/Guardians have continuous digital access to the organization's Family Handbook, which can be accessed through the link below. The handbook covers all key policies and procedures, including but not limited to tuition, technology, safety and security, and the code of conduct.
By signing below, I confirm that I agree to these terms and conditions and accept full responsibility for all tuition payments and adherence to all policies outlined in the Family Handbook and Tuition Policy.*

Clear
Should be Empty:

Program Enrollment

Parent/Guardian Information

Child 1 General Information

Child 1 Medical Information

Child 1 Program and Schedule

Early Learning Academy Enrollment

K- 5 Program Enrollment

Teen Program Enrollment

Child 1 Program Permissions

Mentoring Program

Transportation

Photo Release

Authorization for Medical Treatment

School District Partnership:

Child 2 General Information

Child 2 Medical Information

Child 2 Program and Schedule

Early Learning Academy Enrollment

K- 5 Program Enrollment

Teen Program Enrollment

Child 2 Program Permissions

Mentoring Program

Transportation

Photo Release

Authorization for Medical Treatment

School District Partnership:

Child 3 General Information

Child 3 Medical Information

Child 3 Program and Schedule

Early Learning Academy Enrollment

K- 5 Program Enrollment

Teen Program Enrollment

Child 3 Program Permissions

Mentoring Program

Transportation

Photo Release

Authorization for Medical Treatment

School District Partnership:

Child 4 General Information

Child 4 Medical Information

Child 4 Program and Schedule

Early Learning Academy Enrollment

K- 5 Program Enrollment

Teen Program Enrollment

Child 4 Program Permissions

Mentoring Program

Transportation

Photo Release

Authorization for Medical Treatment

School District Partnership:

Emergency Contacts

Authorized Pick-up Information

Household Information

Enrollment Acknowledgements