BGCCA Universal Registration Form

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BGCCA Universal Registration Form

BGCCA Mission
Our mission is to inspire and enable young people, especially those who need us most, to realize their full potential to become productive, caring responsible citizens.

Our programs are designed to inspire creativity, foster academic success, and promote healthy life choices. With a focus on community and personal development, we ensure every youth has the opportunity to discover their potential. Join us in building a brighter future through after school programs tailored to empower and engage young minds.

This form allows us to track expected program participation and actual program attendance during each session. By completing this form you are agreeing to attend and participate in BGCCA program events and activities for the duration of the session (generally a 2 to 3 month term), either for yourself or your child. Most programs are available in both our Albany and Troy Clubhouses, with some exceptions, based on your location preference. Please complete each section below to the best of your availability and come to the Clubhouse when sessions begin, thank you.

Member's Personal Information

First Name *

Last Name *

Date of birth *

Age *

Gender *

Male

Female

Non-binary

Prefer not to say

Other:

Race/Ethnicity

American Indian or Alaska Native

Asian

Black or African American

Hispanic/Latino

Native Hawaiian/Other Pacific Islander

Two or more Races

White

Other:

Address *

City *

State *

Home/Cell Phone Number

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