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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Registration Type *

Registration for Boys & Girls Club of Greater Santa Rosa - 1011 Hahman Drive *

I understand that I am registering my child for The Boys & Girls Club of Greater Santa Rosa. This club is not housed on a school campus. I further understand that I will not be issued a refund for registration fees.

Member Information

Child's name *

First Name

Last Name

Primary phone *

Address *

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Child's Birthdate

Gender

School your child attends

Grade (Please Note: Your child must be enrolled in Kindergarten to attend. TK not permitted.)

Returning member?

Specify school if registering for after school transportation

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

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