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Summer Registration Form 2023
Framingham Clubhouse
PLEASE NOTE: 1) If your child is NOT a member please fill out a Membership form as well. Membership is $25/annually per child.
Please visit www.bgcmetrowest.org/framingham-after-school to fill out the membership form
2) You are required to pay a non-refundable DEPOSIT OF $25 per week per child to secure a spot in the 2023 Summer Program.
***Payment will be collected at the end of this form.
***FULL WEEKS***
CALL THE OFFICE AT 508 620 7145 TO BE ON WAITING LIST!
Ages 8-9 - Weeks FULL
Ages 5-7 - FULL
Ages 10+ - FULL
Child's Information
Child's Name
*
Sex
*
Birthdate
*
/
Month
/
Day
Year
Date
Address
*
Address
Street Address Line 2
City
State / Province
ZIP
School
*
Age
*
Grade
*
Phone #
*
Child's Hair Color
*
Eye Color
*
Height
*
Weight
*
Swimming Ability
*
Identifying Marks
*
Does your child have any physical restrictions?
*
List any Medical, Physical, or Emotional conditions that we should be aware of to better serve your child:(allergies, medication, etc)
*
Parent / Guardian #1 Information
Name of Parent / Guardian #1
*
Cell #
*
Email
*
example@example.com
Home #
*
Please enter a valid phone number.
Address
*
Street Address
City
Postal / Zip Code
Parent / Guardian #2 Information
Name of Parent / Guardian #2
Cell #
Email
example@example.com
Home #
Address
Address
Street Address Line 2
City
State / Province
ZIP
Emergency Contacts
In Case of an Emergency, and if a Parent/Guardian cannot be reached:
Name
*
Address
*
Relationship
*
Phone Number
*
Please enter a valid phone number.
Name
Address
Relationship
Phone #
Name
Address
Relationship
Phone #
Please mark off the week(s) you are registering for.
* You are required to pay a non-refundable DEPOSIT OF $25 per week per child to secure a spot in the 2023 Summer Program.
***Payment will be collected at the end of this form.
How many weeks are you signing up for? This should correspond with the amount of checks in the table above.
*
Please Select
1
2
3
4
5
6
7
8
AUTHORIZATION AND CONSENT FORM
I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child. However, if I cannot be reached, I hereby authorize the qualified staff at the Boys & Girls Club to transport my child to the nearest hospital.
Child's Doctor
*
Child's Insurance
*
Doctor Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I give consent to have my child photographed or videotaped for public relations purposes.
*
YES
NO
PARENT/GUARDIAN SIGNATURE
*
Clear
DATE
*
/
Month
/
Day
Year
Date
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