25 - 26 Membership Form

1

Please list the children in your household that are registered for the Club. The following household information will only pertain to the children listed below.* This field is required.Click the green plus sign (+) to add children.

2

Are the members listed above U.S. citizens?* This field is required.

YESNO

3

Does your child (or do your children) have documentation that allows them to attend school in the United States?

Yes

Prefer not to answer

No

4

Member Race/Ethnicity* This field is required.Select all that apply

American Indian or Alaska Native

Middle Eastern or North African

Asian

Native Hawaiian or Pacific Islander

Black or African American

White

Hispanic or Latino

Another Identity

5

What is the primary language spoken in the home?

6

How many people are living in your household? * This field is required.

7

How many of these people are adults (18+)* This field is required.

8

How many of these adults are currently employed?* This field is required.

9

How many of these adults are in post-secondary school?* This field is required.

11

Please select your household income.* This field is required.

Less than $30,000

$30,000 - $50,000

$50,000 - $70,000

$70,000 - $90,000

$90,000 and above

12

Is anyone in the household in the military?* This field is required.

YESNO

13

Active Duty or Reserves?

Active Duty

Reserves

14

Parent/Guardian Name:* This field is required.

First Name

Last Name

15

Parent/Guardian Signature:

Clear