Boys & Girls Clubs of Sonoma-Marin Summer Camp Registration

Boys & Girls Clubs of Sonoma-Marin Summer Camp Registration

Summer Camp is offered in 9 Communities!

Select the Community to see more information
Select a Community

CloverdaleGeyservilleHealdsburgWindsorGuernevilleSanta RosaRoselandRohnert ParkPetaluma

Parent/Guardian Information

In this section, we will collect contact information for both the Primary and Secondary Parents/Guardians.

Primary Parent/Guardian Information
Primary Parent/Guardian Name

First NameLast Name
Primary Parent/Guardian's Relationship to Child(ren)
Primary Parent/Guardian Cell Phone
Please enter a valid phone number.
Primary Parent/Guardian Email
example@example.com
Primary Parent/Guardian Place of Work
Primary Parent/Guardian Work Phone
Please enter a valid phone number.
Primary Parent/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is there a Secondary Parent/Guardian to add?

YesNo

Secondary Parent/Guardian Information
Secondary Parent/Guardian Name

First NameLast Name
Secondary Parent/Guardian Relationship to Child(ren)
Secondary Parent/Guardian Cell Phone
Please enter a valid phone number.
Secondary Parent/Guardian Email
example@example.com
Secondary Parent/Guardian Place of Work
Secondary Parent/Guardian Work Phone
Please enter a valid phone number.
Is the address the same as the Primary Parent/Guardian?

YesNo
Secondary Parent/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home & Financial Assistance Programs

In this section, we will collect information about the child(rens) living situation and any finaincial aid the family recieves.

Home & Financial Assistance Programs
How many people live in the home including the child(ren)?
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Does the family receive any of the following? (check all that apply)

CalWORKSHousing AssistanceFood StampsNone of the AboveFree/Reduced Lunch
Does the family receive child care support from 4C's or any other subsidy?

YesNo

Emergency Contacts

In this section we will collect 2 alternative contacts to call in the event that the Primary and Secondary Parent/Guardians cannot be reached. Additionally, we will collect Medical and Health Insurance information.

1st Alternative Contact

In the event that we are unable to reach the Primary and Secondary Parent/Guardian, who should we call next?
1st Alternative Contact Name

First NameLast Name
1st Alternative Contact Relationship to Child(ren)
1st Alternative Contact Cell Phone
Please enter a valid phone number.
1st Alternative Contact Place of Work
1st Alternative Contact Work Phone
Please enter a valid phone number.

2nd Alternative Contact

In the event that we are unable to reach the Primary and Secondary Parent/Guardian OR the 1st Alternative Contact, who should we call?
2nd Alternative Contact Name

First NameLast Name
2nd Alternative Contact Relationship to Child(ren)
2nd Alternative Contact Cell Phone
Please enter a valid phone number.
2nd Alternative Contact Place of Work
2nd Alternative Contact Work Phone
Please enter a valid phone number.

Medical and Health Insurance
Health Insurance Provider
Physician's Phone
Please enter a valid phone number.
Physician's Name

First NameLast Name

Member Information

"Member refers to the child you are enrolling. Information is entered one Member at a time. There will be an opportunity to add another child after all information on the firsl child is collected.

Do you want to register another Child?

YesNo

Camp Details & Payment

In this section you will be able to select Summer Camp Sessions by week and time frame.

Total Due

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USDDescription

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