Parent/Guardian Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's Name
First Name
Last Name
Age
Gender
Please Select
Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond
Grade
School
Ethnicity
Please Select
hispanic/latino
asian/pacific islander
2 or more races
african american
caucasian
american indian/alaskan native
Family Setting
Please Select
Both Parents
Mother Only
Father Only
Grandparents
Foster Parents
Legal Guardian
Other Family Member
Other
Is either parent of the member actively serving in the military?
Yes
No
Is your child currently a Member of Boys & Girls Clubs of Monterey County?
Yes
No
What Clubhouse does your child normally attend?
Please Select
Seaside Clubhouse
Salinas Clubhouse
Is your child eligible for free/reduced lunch?
Yes
No
For virtual programming, does your child have access to the following?
By selecting agree, you grant permission for your child to participate in Virtually BGCMC - An Online Club Experience
Agree
Does Not Agree
I grant permission to Boys & Girls Clubs of Monterey County to use my child's photo on social media to promote the Virtual Membership
Yes
No
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