Grandparents Raising Grandchildren Association (GRGA) Membership Application
Please complete the form below and confirm the acknowledgment.
After submission please email us at GRGAMiami@gmail.com to let us know you have completed the form.
A member of our staff will reach out to confirm receipt.
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FULL NAME *
CELL PHONE *
ALTERNATE PHONE
EMAIL *
FULL ADDRESS (INCLUDE CITY, STAT, ZIP)
NAME, AGE, AND DOB OF EACH GRANDCHILD/ KIN/ DEPENDENTS
Check which status best describes your role:
Check your work status:
Please share some of the challenges and needs you would like GRGA to help you with as it relates to raising your grandchildren/dependents.
Please check days and times of availability for events, activities, and volunteer projects.
By typing my name and submitting this form, I agree to become a member of GRGA, Inc. and receive services for myself and the grandchildren/dependents in my care. I also grant GRGA, Inc. permission to share our information with third parties in order to receive support and services. I also grant GRGA, Inc. permission to include our family in all media collateral and our image and likeness may be used on behalf of the organization and sponsors. I also agree that as a member family, we will volunteer as needed with or on behalf of the organization each active year in exchange for membership services.                                                                                    
TYPE NAME BELOW.
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