MEMBERSHIP ONLY!

Annual membership starts the day you register.

 

Quantity
Price
Total
Membership Only

Membership is valid for one year from the date of registration. This also includes the $3 online convenience fee.

X
$
58.00=
$
0

Would you like to sponsor another child's membership?

Sponsorship of another child's membership.

X
$
55.00=
$
0

Final Total:
$
0

Contact Information

Country*
Email*
Confirm Email*
Phone*

Member Info

Which Club is your home club?*
  • Whitestown Club
  • Zionsville Club
Sports - Child - First Name*
Sports - Child - Last Name*
Sports - Child - DOB*
Sports - Child - Ethnicity*
Sports - child - health problem explain
Sports - child - school

  PARENTAL PERMISSION AND RELEASE AND INDEMNITY AGREEMENT

I hereby give permission for my child, named above, to join the Boys & Girls Club of Zionsville ("The Club") and permission for my child to participate in the Clubs' program, activities, field trips, and top visit and use the Club's surveys, interviews, and focus group discussions.  Data collected from various vehicles is private and confidential.  It is also understood that the data collected will protect my child's identity, although the club, its assigns or successors, may use the data to determine current trends.  The data collected is the sole property of the Club.  I am the natural parent or legal guardian having custody of said child.  In consideration of my child being accepted for membership and Participation in the Club and activities, I hereby release and agree to hold harmless and Indemnify the Boys & Girls CLub of Zionsville and each of its directors, officers, employees, volunteers, and agents from and against any and all liability, claims, demands, actions, damages, expenses, and cost, including attorney fees, losses, and judgements of whatsoever kind and nature which may result from or arise out of my child's membership in the Club, Participation in the Club's program, activities and field trips and Clubs' facilities, whether or not resulting in whole or in part negligence, ac ts or omission of Boys & Girls Club of Zionsville or its directors, officers, employees, volunteers, or agents or of said child.

Parent Information

Sports - child - father first name
Sports - child - father last name
Sports - child - father home phone
Sports - child - father cell phone
Sports - child - father email
Sports - child - father employer
Sports - child - father work phone
Sports - child - mother first name
Sports - child - mother last name
Sports - child - mother home phone
Sports - child - mother cell
Sports - child - mother email
Sports - child - mother employer
Sports - child - mother work phone

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code

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