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 :
*
First Name
Last Name
Email of person referring student:
*
example@example.com
Phone Number of person referring student:
-
Area Code
Phone Number
Name of student:
*
First Name
Last Name
Student's Current Grade Level (for Summer, use the next school year)
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
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?
Submit
Should be Empty: