By using this link, you are registering your child(ren) at the
Boys & Girls Clubs of the Emerald Coast-PENSACOLA-MONTCLAIR CLUB
located at 820 Massachusetts Ave. Pensacola, FL 32505
Up to two children (of the same household only) can be registered through this link.
To register additional children, complete this form then open the link again for a new application form.

To avoid being timed out or loosing registration progress please be prepared with the following items before continuing:
1. Child(ren)'s Club (Current) Membership Number
2. Child(ren)'s School Information
3. Child(ren)'s Student Identification Number (FULL-School Issued)
4. Insurance Information (Provider and Account

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* 1. Are you registering more than one child at this location, at this time?

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* 2. CHILD #1: Member Identification

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* 3. CHILD #1: Racial/Ethnic Identity

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* 4. CHILD #1: Medical Authorizations

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* 5. CHILD #1: Member Lives With (check all that apply)

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* 6. CHILD #1: Household Information

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* 7. CHILD #1: Does your child qualify for FREE or REDUCED LUNCH at school?

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* 9. CHILD #1: General Authorizations

YES NO
I authorize my child's photograph to be used in promotional/public materials.
I authorize my child to participate in all Club activities in or adjacent to the Club building.
I authorize my child to be transported by Boys & Girls Clubs.
I authorize my child to participate in SMART Moves Programs and other prevention programs.
I authorize Boys & Girls Clubs to collect information from the school my child attends, regarding his/her grades and or behavior at school (including report cards, progress reports, extracurricular activities, disciplinary action, etc).
Registration for CHILD #2 Begins Here.
IF THIS DOES NOT APPLY TO YOU, SKIP AHEAD TO THE DISCLOSURE.

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* 10. CHILD #2: Member Identification

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* 11. CHILD #2: Racial/Ethnic Identity

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* 12. CHILD #2: Medical Authorizations

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* 13. CHILD #2: Member Lives With (skip if same as CHILD #1)

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* 14. CHILD #2: Household Information (skip if same as CHILD #1)

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* 15. CHILD #2: Does your child qualify for FREE or REDUCED LUNCH at school?

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* 17. CHILD #2: General Authorizations

YES NO
I authorize my child's photograph to be used in promotional/public materials.
I authorize my child to participate in all Club activities in or adjacent to the Club building.
I authorize my child to be transported by Boys & Girls Clubs.
I authorize my child to participate in SMART Moves Programs and other prevention programs.
I authorize Boys & Girls Clubs to collect information from the school my child attends, regarding his/her grades and or behavior at school (including report cards, progress reports, extracurricular activities, disciplinary action, etc).

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* 18. DISCLAIMER:
I hereby submit this application for my child(ren)'s membership to the Boys & Girls Clubs of the Emerald Coast. I understand that by entering my full name below, I will be enrolling my child in Boys & Girls Clubs Programs. I understand that programs are deigned to provide academic, health, and character enrichment. It is expressly understood and agreed by the undersigned that the Boys & Girls Clubs of the Emerald Coast is not liable for the loss of property or injury directly resulting from Boys & Girls Clubs of the Emerald Coast negligence or willful act of an employee of the organization. 
I understand and accept the organization's Registration and Membership Fee Schedule, Reimbursement and Late Fee Policies, and Authorized School Communication on the part of Boys & Girls Clubs with School officials regarding my child's grades, progress, behavior, participation in extracurricular activities etc. of which I authorize. By signing and submitting this application, it is also understood that parents must attend a mandatory parent orientation at the beginning of the school year and summer program, annually. 
I fully understand and agree to all the conditions stated on this form and have counseled my child to confirm these rules and the authority of employees of the Boys & Girls Clubs of the Emerald Coast.

PLEASE BE ADVISED!
By selecting SUBMIT REGISTRATION APPLICATION below, you submit this application only.
Next, contact the Club to confirm this application has been received.
Visit the Club to pay any previous balances (if applicable) and pay required new school year registration fees in full.
At that time, you will receive CONFIRMATION OF REGISTRATION and information on PARENT ORIENTATION OPTIONS
REGISTRATION IS NOT FINAL UNTIL ALL ABOVE REQUIREMENTS ARE COMPLETED.

Thank you for your continued membership and letting us be a part of your child(ren)'s lives!

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