Online Guest Pass Submittal

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Submit this info to have your child attend the Boys & Girls Club of Lunenburg on a Guest Pass (good for 3 visits). The BGCL is open to local area youth grades 6-10. On a regular after school day we are open 2:30-6:30pm. If you have any questions call the Clubhouse at 978-582-6407.

You can save and print the guest pass or submit the information below (no printing required).

Child Name, School and school grade? *

Child Date of Birth *

YYYY

Parent/Guardian Name *

To ensure the staff are aware of your child's arrival, please contact the Clubhouse at 978-582-6407 or email robinbaldwin@bgcluboflunenburg.org *

I understand that I must speak to a staff member before sending my child to the BGCL

Required

How is your child leaving the BGCL?

Parent pick up

Walking home

Clear selection

Parent Agreement *

I do hereby give my son/daughter permission to attend and participate in activities sponsored by the Boys & Girls Club. I hereby release the Boys & Girls Club, its employees, associates and contributors from liability from any injury, loss or theft incurred by my son/daughter while participating. Furthermore, I hereby authorize medical examination and emergency treatment for my son/daughter by a qualified licensed physician in the event of an accident. I understand that the costs for such treatment will be my responsibility.

Required

Any medical conditions or behavioral concerns we should be aware of?

Phone numbers of parent/guardian/emergency contact *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms