Beta Club Parent Questionnaire
Parent’s Name
First Name
Last Name
Parent Email
example@example.com
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What days and times will NOT work for your child with Beta Club meetings?
1st Child’s Name
First Name
Last Name
2nd Child’s Name
First Name
Last Name
3rd Child’s Name
First Name
Last Name
Child’s Age & Grade Level
Child's Birthday
What are your child’s interests?
What do you want your child to gain from being a member of Beta Club?
Submit
Should be Empty: