Member Application & Registration Form

Member Application Form

Thank you for your interest in applying to become a member of Way Club. We look forward to reviewing your application. If you have any questions or issues with the application, please contact Monique Harrington, at mharrington@wayclub.org or 610-864-6967.
General Information
Member Name *

First Name Middle Name Last Name
Preferred Name (Nickname)
Gender *
Birth Date *

Month Day Year
Age *
High School *
Grade *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Member E-mail *
example@example.com
Member Mobile Number *
Parent/Guardian Name *

First Name Last Name
Parent/Guardian Relationship To Applicant *
Parent/Guardian Email *
example@example.com
Parent/Guardian Phone Number *
Please enter a valid phone number.
Have you attended a Way Club Info Session? *

Yes No
Why would you like to be a member of Way Club? *
How will you bring value to the social club? *
What are your favorite social activities and interests? *
What career paths are you currently interested in? *
Please list any extracurricular activities you participate in. *
If accepted, I agree to attend and fully participate in the 2-Week Summer Growth Academy. The 2022 program dates are July 11-22. *

I agree
How did you hear about The Way Club? *
T-Shirt Size
Please provide your t-shirt size below. *

XS S M L XL 2XL
Youth Code of Conduct

The primary purpose of the Way Club Youth Code of Conduct is to ensure the safety and well-being of all participants at events and activities. It applies to all participants including the members, their parents, and volunteers.
As a member of Way Club, I will:
- Conduct myself in a courteous manner and treat members, parents, volunteers, staff, and others with respect. Appropriate language and behavior are expected at all times.
- Respect and adhere to the rules and guidelines of the club.
- Uphold an individual’s right to dignity by supporting an environment of inclusion which welcomes involvement of participants from all backgrounds.
- Obey local, state and federal laws.
I understand if I fail to adhere to the above Code of Conduct, I will be subject to disciplinary action and potentially prohibited from attending and participating in events and future programs at Way Club.

By signing below I confirm that I have reviewed and agree to adhere to the Way Club Code of Conduct.
Code of Conduct: Signature of Member *

Clear
Date of Signature *

Month Day Year
Date
Application Year
Accepted
Notes
Should be Empty:

Member Application Form

General Information

T-Shirt Size

Youth Code of Conduct