Virtual Membership Registration

Virtual Membership Registration
Welcome to Virtually BGCMC - An Online Club Experience, brought to you by Boys & Girls Clubs of Monterey County!

Aimed at keeping youth engaged, supported, and having fun, Boys & Girls Club Staff recognize members through special shout outs, Club Dollars, and more, just like they would if they were in a physical Clubhouse. On-demand sessions are available for anyone to participate in. To participate in live programming, you must be a Clubhouse Member or a Virtual Member.

Our commitment to keeping the young people we serve safe is always our number one priority. Boys & Girls Clubs of Monterey County will actively monitor member activity on Zoom and will make every effort to protect member information by, among other things, maintaining control of, and access to, the data collected; prohibiting re-disclosure of member information; limiting the purposes for which the online platforms may use member information; ensuring there is no advertising and that no member information is collected for commercial purposes.

Virtual Membership is FREE!
Parent/Guardian Contact Information
Name (First & Last) *
Phone Number *
Email Address *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Member Information
Child's Name (First & Last) *
Age *
Gender *

Male Female Prefer not to say
Grade *
School *
Ethnicity *

Asian or Pacific Islander Black or African American Hispanic or Latino Native American or Alaskan Native White or Caucasian Two or more races
Family Setting *

Mom Only Dad Only Both Parents Grandparents
Is either parent of the member actively serving in the military? *

Yes No
Additional Child(ren)'s Information
Name, Grade, and School
Is your child currently a Member of Boys & Girls Clubs of Monterey County? *

Yes No
What Clubhouse does your child normally attend?
Is your child currently a Member of another Boys & Girls Club? *

Yes No
What Clubhouse does your child normally attend?
Is your child eligible for free/reduced lunch? *

Yes No
For virtual programming, does your child have access to the following? *

Laptop Computer Desktop Computer Tablet Smart Phone Internet
Community Development Block Grant Beneficiary Intake Form for Gonzales Youth

Parent Permission Form for Free Virtual Program Services from the Boys & Girls Club
Does your child reside in or go to school in Gonzales? *

Yes No
How many people live in your home?
Is your child(ren) eligible for school free or reduced lunch program?

Yes No
How many child(ren) are eligible for school free or reduced lunch program?
What is your race:

American Indian or Alaskan Native Asian Black or African American Native Hawaiian or other Pacific Islander White American Indian or Alaskan Native & White Asian & White Black or African American & White Other Multiple Race Combinations Prefer not to answer
What is your ethnicity

Hispanic or Latino Not Hispanic or Latino Prefer not to answer
Parent/Guardian Permissions
By selecting agree, you grant permission for your child to participate in Virtually BGCMC - An Online Club Experience *

I agree I do not agree
I grant permission to Boys & Girls Clubs of Monterey County to use my child's photo on social media to promote the Virtual Membership *

I agree I do not agree
Please type your full name here: *
Please sign here: *

Clear
Should be Empty:

Virtual Membership Registration

Parent/Guardian Contact Information

Member Information

Community Development Block Grant Beneficiary Intake Form for Gonzales Youth

Parent/Guardian Permissions