2020-2021 After School Enrollment
Thank you for your interest in the After School Program at the Boys & Girls Club of the Berkshires. All forms are confidential. If you have any questions, please contact me at KHayes@bgcberkshires.org
Email address *
Child Information
Child's Name: *
Preferred Name:
Gender: *
Date of Birth: *
Age at Admission: *
Grade Entering: *
School *
Child's Home Address *
Home Phone Number *
Cell Phone Number *
Identifying Marks (i.e freckles, birth mark, scar, etc)
Sex: *
Height/Weight/Hair Color/Eye Color- Identifiers *
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