East Side Membership Form

Thank you for your interest in joining a Boys & Girls Club of the Twin Cities!

Member Information

MM/DD/YYYY
Check all that apply.

Parent/Guardian (Emergency Contact)

Household Information

Per Year
Service Branch and Status.

Member Medical Information

Please list any/all medications the member is taking.

Emergency Contact Other Than Parent/Guardian

TERMS OF AGREEMENT

This organization participates in the Sprockets network, a youth program research collective, and other program improvement research initiatives which aim to improve the quality and availability of after-school and summer programs for youth and their families in the Twin Cities. Information about your child's participation in this activity will be used to help assess the quality and effectiveness of out of school time programs. Information about your child will be kept confidential and your child will never be identified in any evaluation or research reports. You have the right to review the Data Privacy Notice. If you do not want your child's date to be included in evaluation or research related to Sprockets, or other program improvement research initiatives, please tell our staff.
I authorize data sharing related to my child with the Sprockets,YMCA, Beacons Network, Boys & Girls Club of the Twin Cities, Richfield Public School and Minnesota Department of Education.  Information about your child’s participation in this activity will be used to help assess the quality and effectiveness of out of school time programs. Information about your child will be kept confidential and your child will never be identified in any evaluation or research reports. You have the right to review the Data Privacy Notice. If you do not want your child’s data to be included in evaluation or research related to Sprockets, or other program improvement research initiatives, please tell our staff and sign the non-consent form. This will NOT affect your child’s participation in the program.

GET INVOLVED

Join our community to ensure bright futures for youth in the Twin Cities!

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