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? *

Enrollment Type *

Summer Camp Full Time - $175/week (3-5 Days) - Beginning June 7
Summer Camp Part Time - $70/week (1-2 Days) - Beginning June 7
School Year Full Time - $700/month (5 Days) - Ending May 28
School Year Part Time - $425/month (5 days, morning or afternoon session) - Ending May 28

Desired Start Date *

Member Information

Child's Name *

First Name

Last Name

Primary phone

Area Code

Phone Number

Address

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Child's Birthdate

Gender

School your child attends *

Grade (Most Recently Completed for Summer Registration) *

Members must be 5 years old and enrolled in Kindergarten for the school year to attend. No TK.

Returning member?

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

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

How Did You Hear About Us? *