2026-2027 Preschool Membership Application

2026-2027 Preschool Membership Application

Children must be at least 3 years old and no older than 5 by September 1, 2026 to attend the Boys & Girls Club of Canyon County Preschool Program. In order to qualify, you must live within the boundaries of Park Ridge, Central, Iowa, Endeavor, Sherman, or Willow Creek Elementary. Applications for children under 3 & older than 5 will not be accepted. Your child must be FULLY independent in the bathroom in order to qualify. You will be notified via email if your child was accepted into the program.
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Child's Age
The BGCN Preschool Program is for children 3-5 years old only. Child must be at least 3 and no older than 5 by Sept 1, 2026 to qualify.
Gender
My child lives within the boundaries of:
Not sure if you live within the listed boundaries? Click the link below to enter your address on the Nampa School District online look up tool.

https://app.guidek12.com/nampaid/school_search/current/
Does child live with:

Other
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Primary Phone

Area CodePhone Number
Primary E-mail
Mother's/ Guardian Name

First NameLast Name
Mother/Guardian Cell

Area CodePhone Number
Employer
Work Phone

Area CodePhone Number
Father's/ Guardian Name

First NameLast Name
Father/Guardian Cell

Area CodePhone Number
Employer
Work Phone

Area CodePhone Number
Siblings that Attend BGCN
Emergency Information
Emergency Contact (other than parent)

First NameLast Name
Phone

Area CodePhone Number
Relationship
Frequent Pick-ups (other than listed above)
#1 Name
Relationship
Phone
#2 Name
Relationship
Phone
#3Name
Relationship
Phone
Family Assistance

Other
Special Needs
Allergies
Medications
I confirm my child is independent in the bathroom. (Children MUST be independent in order to attend the Preschool Program.)
I understand that if my child's behavior is deemed unacceptable by staff or the director, my child may be suspended or removed from the program.
I understand I must provide a copy of my child's birth certificate.
FAMILY DATA: The following information is strictly confidential. Compilation of data is required for private and public funding sources and also helps the Boys & Girls Clubs to measure program effectiveness.
Number of Brothers
Number of Sisters
How many people live in your home
Annual Family Income $
Ethnicity

Other
My digital signature below acknowledges I have read the entire 2021 Membership Form, understand the same, and agree to be bound thereby.
Name

First NameLast Name
PARENT/GUARDIAN INVESTMENT OPPORTUNITY: As a parent/guardian we clearly understand the value of the program and services my child will receive at the Boys & Girls Club of Nampa. I/we believe in supporting the program in which our children are involved in and would like to donate/invest:

Other
Questions
Comments
Should be Empty: