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

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? *

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