Boys & Girls Club Membership Application

/Boys & Girls Club Membership Application
Boys & Girls Club Membership Application2018-11-08T12:52:55-08:00

Complete your child’s registration filling this form.

  • Parent/ Guardian Contact Information

  • Email Address

  • **Please enter your address to receive program and registration updates by Email
  • Member Lives With

  • Other than parent, Emergency Contact Person

  • Medical Data

  • PERSON(S) NOT AUTHORIZED TO CONTACT MEMBER

    Please note that legal documentation must be presented
  • GREAT FUTURES START HERE

    This information will be kept in strict confidence. This information is important because it makes the Boys & Girls Club eligible to receive various grant funding. It also helps us to identify members who qualify for FREE eye care including eye exam and glasses.
  • Please agree for approval or mark N/A:

  • OPEN DOOR POLICY In keeping with Boys & Girls Club policy across the country our drop-in program operates with an open door policy. The decision regarding when the child leaves the Club, and with whom, is strictly between parent and child.