Boys & Girls Club of Greater Santa Rosa

Note: You are registering for the Boys & Girls Club of Greater Santa Rosa located at 1011 Hahman Drive Santa Rosa, CA 95405

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Which Program Are You Registering For? *

Desired Start Date *

Month

Day

Year

School Year Registration Opens July 1, 2022

Returning member?

How Did You Hear About Us? *

Member Information

Child's Name *

First Name

Last Name

Child's Birthdate *

Month

Day

Year

Gender *

School your child attends *

Grade (Most Recently Completed for Summer Registration) *

Members must be entering 1st Grade in the 2022/23 School Year.

Do you receive any of the following? Check all that apply.

Special Needs (IEPs); Known Allergies, Illnesses, or Injuries; Medications