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 *

Please note, if you are registering for Summer Camp, your registration is not complete until we receive your Registration Selection Calendar. We will email this form to you. You must select the weeks your child will attend camp before camp begins on June 1. Payment is collected by the week and due the Friday before your child will attend.

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 (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?

Are you requesting van pick up from school? *

Specify school if registering for after school transportation

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

4C’s (Community Child Care Council of Sonoma County)
Sonoma Works
Free/Reduced Lunch
None of the Above

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

Register

Member Information