After School Membership Interest Form
This form is NOT an official membership form, official membership forms will be sent out at a later date and payment will be due within 3 days of acceptance. This form is first come first serve and those remaining will be put on a waiting list.

If your child is in 8th Grade or above please fill out the teen membership interest form.
Parent/Guardian First & Last Name *
Parent/Guardian Relation to Child *
Parent/Guardian Phone Number *
Additional Parent/Guardian Phone Number
Parent or Guardian's frequently checked email *
Child #1 First & Last Name *
Child #1 Age as of 8/10/2020 *
Child #1 Grade for the 2020/2021 School year *
Child #1 School - Please note if entering "other" transportation will not be provided by The Club or School *
Child #2 First & Last Name
Child #2 Age as of 8/10/2020
Child #2 Grade for the 2020/2021 School year
Child #2 School - Please note if entering "other" transportation will not be provided by The Club or School
Clear selection
Child #3 First & Last Name
Child #3 Age as of 8/10/2020
Child #3 Grade for the 2020/2021 School year
Child #3 School - Please note if entering "other" transportation will not be provided by The Club or School
Clear selection
Child #4 First & Last Name
Child #4 Age as of 8/10/2020
Child #4 Grade for the 2020/2021 School year
Child #4 School - Please note if entering "other" transportation will not be provided by The Club or School
Clear selection
I Understand that this form is NOT a membership form and does NOT guarantee my child a spot at the Boys & Girls Club. *
Required
I Understand my child will be required to wear a mask while attending The Boys & Girls Club *
Required
If your child is unable to come to the Club would you like to receive blue bag deliveries
Clear selection
If yes please enter your home address
Submit
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