SGYC Membership Waiver 2021

Page 1

MEMBERSHIP APPLICATION ST. GEORGE YOUTH CENTER, Isla Vista Parent/Guardian Information First name

Last name

DOB

Relationship to Member

First name

Last name

DOB

Relationship to Member

Address

City

Home Phone

Cell Phone

State

Work Phone

Zip code

Can you receive text msg?

Email Prefered Language Spoken At Home (for grants)

Highest School Completion By Parents/Guardian (for g rants)

Do You Qualify For Free/Reduced Lunch At School (for grants) Other contact in case of emergency

Household Size (for grants) Telephone

Relationship to member

Y outh in Family First Name

Last name

Relationship to member

Date of birth

Y outh in Family First Name

Member? Yes No Last name

Relationship to member

Date of birth

Last name

Relationship to member

Date of birth

Member? Yes No Gender Grade

Last name

Relationship to member

Date of birth

Member? Yes Gender

No Grade

Last name

Relationship to member

Date of birth

Member? Yes Gender

No Grade

Last name

Relationship to member

Date of birth

Y outh in Family First Name

Y outh in Family First Name

Y outh in Family First Name

Y outh in Family First Name

Member? Yes No Gender Grade

Gender

Grade

Member? Yes No Gender Grade


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SGYC Membership Waiver 2021 by Channel Islands YMCA - Issuu