Boys & Girls Club 2025 School Year Pre-Registration Form

1
Child 1 - Information* This field is required.
First Name
Last name
Child's grade for the 2025/2026 school year
Date Of Birth (MM/DD/YYYY)
School child will attend during the 2025/2026 school year
2
Do you need to register more than 1 child?* This field is required.
YESNO
3
How Many More?* This field is required.Please select the amount of extra applicants that will have to be registered.
1
2
3
4
5
4
Child 2 - Information* This field is required.
First Name
Last name
Child's grade for the 2025/2026 school year
Date Of Birth (MM/DD/YYYY)
School child will attend during the 2025/2026 school year
5
Child 3 - Information* This field is required.
First Name
Last name
Child's grade for the 2025/2026 school year
Date Of Birth (MM/DD/YYYY)
School child will attend during the 2025/2026 school year
6
Child 4 - Information* This field is required.
First Name
Last name
Child's grade for the 2025/2026 school year
Date Of Birth (MM/DD/YYYY)
School child will attend during the 2025/2026 school year
7
Child 5 - Information* This field is required.
First Name
Last name
Child's grade for the 2025/2026 school year
Date Of Birth (MM/DD/YYYY)
School child will attend during the 2025/2026 school year
8
Child 6 - Information* This field is required.
First Name
Last name
Child's grade for the 2025/2026 school year
Date Of Birth (MM/DD/YYYY)
School child will attend during the 2025/2026 school year
9
Primary Parent / Guardian* This field is required.Your Email is required in order for you to receive a confirmation of your submission.
Full Name
Relationship To Child
Email Address
Phone Number
10
Secondary Parent / Guardian (Optional)Your Email is required in order for you to receive a confirmation of your submission.
Full Name
Relationship To Child
Email Address(Optional)
Phone Number
11
Club Selection* This field is required.
Pine Club – Open to Pine Elementary School students in grades K-6
Springfield Club – Open to Springfield Elementary School students in grades K-6
Charles R. Westcott Club (Michigan City)– Open to all area students in grades K-8
Kingsford Heights Club – Open to Kingsford Heights Elementary School students in grades K-4 AND middle school students in grades 5-8
Kesling Club – Open to Kesling Intermediate School and La Porte Middle School students in grades 5-8
Hailmann Club – Open to Hailmann Elementary School students and former Lincoln Elementary School students in grades K-4
Westville Club – Open to Westville Elementary School and Westville Middle School students in grades K-8
Prairie View Club – Open to students from all NPUSC elementary schools in grades K-5
New Prairie Club – Open to all New Prairie Middle School students in grades 6-8
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