Be A Member

If you are interested in becoming a member, please complete the member's application form below:
Boys & Girls Clubs of North Alabama Membership Application
Choose Club: 
Has the child previously been a Boys & Girls Club member: 
If yes, when and where: 
Is the child currently a Boys & Girls member?: 
If yes where?: 
Child name: 
Gender: 
Age: 
Address: 
City: 
State: 
Zip: 
Date of birth: 
Place of birth: 
Home phone: 
Emergency contact name and number : 
Child's attendence: 
Reason for joining: 
Parent or Guardian's email: 
Mother's name: 
Mother's employer: 
Mother's work phone: 
Father's name: 
Father's employer: 
Father's work phone: 
Do you receive any type of government assistance?: 
If yes what type?: 
Who does the child live with?: 
Number of people in family: 
Number of brothers?: 
Number of sisters?: 
Family income level: 
Name of school: 
Grade: 
Please enter the text in the image: