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Boys & Girls Club Transport Form

Boys and Girls Club logo

We are happy to announce a new after school care opportunity for our students!

Due to the number of families who were not able to utilize Lifeline's after school programming, we have created an additional partnership with the Boys & Girls Club of Elkhart County which provides after school programming to it's members for $30 a year.

We will be providing transportation after school to the Boys & Girls Club of Elkhart County located at Beardsley Elementary School - 1027 McPherson Street, Elkhart, Indiana 46514.

Please use the form below to let us know if you plan to use this option so that we can have record of students needing transportation.

After completing this form you will be re-directed to Boys & Girls Club website to officially register to become a Club Member.

NOTE: On the B&G Club form, you will be asked to select either KidsCare or Club. Please choose Club as KidsCare is not available at the Elkhart location.

Boys and Girls club form note

Should you have any issues or questions regarding the Boys & Girls Club registration form or programming, please reach out to the Boys & Girls Club of Elkhart County directly.

Phone: (574) 295-6838

Student Information

Student First Name (1)*

Answer Required

Student Last Name (1)*

Answer Required

Grade & Teacher*

Answer Required

Student First Name (2)

Answer Required

Student Last Name (2)

Answer Required

Grade & Teacher

Answer Required

Student First Name (3)

Answer Required

Student Last Name (3)

Answer Required

Grade & Teacher

Answer Required

Parent Information

Parent / Guardian 1 First Name*

Answer Required

Parent / Guardian 1 Last Name*

Answer Required

Parent / Guardian 1 Email*

Answer Required

Parent / Guardian 1 Phone*

Number Required

Parent / Guardian 2 First Name

Answer Required

Parent / Guardian 2 Last Name

Answer Required

Parent / Guardian 2 Email

Answer Required

Parent / Guardian 2 Phone

Number Required

By signing this form with an electronic signature below, you are confirming your approval for Premier Arts Academy staff to transport your student to the Boys & Girls Club of Elkhart County after school.

You are also acknowledging that if ever you do not plan to use this programming on any given day, you will contact Premier Arts Academy before 1pm (Mondays-Thursdays) or 12pm (Fridays) to alert our staff of the this change. Failure to do so may result in your student being transported to the Boys & Girls Club of Elkhart County.

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required