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Parent / Guardian Information

Parent / Guardian Name*
Gender*
Address Type of Address Actions
   
There are no Addresses.

Maximum number of addresses reached.

Phone Number Type of Phone Number Actions
   
There are no Phone Numbers.

Maximum number of phone numbers reached.

Email Address Type of Email Actions
   
There are no Email Addresses.

Maximum number of email addresses reached.

(Number living in household)
Please enter a number greater than or equal to 2.
Additional Adult / Guardian
You can add an additional adult - a guardian, spouse, etc.

Spouse / Additional Adult

Parent / Guardian Name*
Gender*
Address Type of Address Actions
   
There are no Addresses.

Maximum number of addresses reached.

Phone Number Type of Phone Number Actions
   
There are no Phone Numbers.

Maximum number of phone numbers reached.

Email Address Type of Email Actions
   
There are no Email Addresses.

Maximum number of email addresses reached.

Member Information

Child Name Select Membership Periods Date of Birth Current Grade Actions
       
There are no Members.

Maximum number of members reached.

Parent / Guardian Agreement

I have read the completed application, understand the rules of the Boys & Girls Club of White County and request that my son(s)/daughter(s) be admitted into membership. I have explained the rules to my son(s)/daughter(s) and agree that the Boys & Girls Club of White County will not be responsible for any accident to the member while on Club premises or while engaged in any of its activities away from the Club.

I understand that this agreement applies to all members I am registering with this form.

Membership Fee & Payment

We encourage those who are able to give above and beyond to help support the program.
Price: $0.00
Payment Type*
I'd like to pay by...
Please bring cash or a check for the Fee Amount to the Club.

You can make checks out to “Boys and Girls Club of White County LLC”.
Credit Card*
We accept:


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This field is for validation purposes and should be left unchanged.

Contact

info@bgcwhitecounty.org

WhiteCountyBoysAndGirlsClub

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Boys & Girls Clubs of America

Proud Partner of:


White County United Way


Twin Lakes School Corp.