Boys & Girls Club Member Referral Form
Please fill out this form to refer a student to the Boys & Girls Club.
Name of person referring student :
Email of person referring student:
Phone Number of person referring student:
Name of student:
Student's Current Grade Level (for Summer, use the next school year)
What is your relationship to the student?
If you work for a school, what is your position?
Which Boys & Girls Club Site location are you referring the student to? Please note, transportation is not provided if the student attends school at a different location.
Albuquerque - Adobe Acres Elementary
Albuquerque - Navajo Elementary
Albuquerque - Valle Vista Elementary
Albuquerque - Harrison Middle School
Albuquerque - Jimmy Carter Middle School
Albuquerque - Grant Middle School
Albuquerque - Kennedy Middle School
Albuquerque - Van Buren Middle School
Albuquerque - Washington Middle School
Albuquerque - Wilson Middle School
Albuquerque - Highland High School
Albuquerque - Del Norte High School
Rio Rancho - Lincoln Middle School
Rio Rancho - Eagle Ridge Middle School
Rio Rancho - Mountain View Middle School
Bernalillo - Bernalillo Elementary School
Bernalillo - Cochiti Elementary School
Bernalillo - Santo Domingo Elementary School
Bernalillo - WD Carroll Elementary School
Bernalillo - Placitas Elementary School
Bernalillo - Algodones Elementary School
How can the Boys & Girls Clubs best serve this student? What do they need help with?
Is there anything else we should know about this student that would help us best serve them?
Should be Empty: