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

2021-22 After School Programming begins Aug 16, 2021

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

After School Transportation Requested *

Pick up from school provided for monthly fee of $75. Transportation routes are subject to change.

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

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