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A Boys & Girls Club membership card has been the key to success for over 100,000 youth in Columbus and millions of youth nationwide. Fill out the membership form below to

Join the Club!

Membership is open to ALL youth ages 6-18.

To pay for your membership online Click Here.

(Please type "Membership" in the Comments Section)

I want to be a Boys & Girls Club Member!


Select Club	:
Member Name (First and Last)	:
Member Age	:
Member Date of Birth	:
Member Gender	:
Phone Number	:
Current Address	:
City	:
State	:
Zip Code	:
Current School District	:
School Name	:
Parent/Guardian #1 (First and Last Name)	:
Relationship	:
Home Phone	:
Work Phone	:
Cell Phone	:
Place of Employment	:
Cell Phone #2	:
Place of Employment #2	:
Parent/Guardian #2 (First and Last Name)	:
Relationship #2	:
Family Doctor or Clinic	:
Doctor/Clinic Phone	:
Allergies to Food/Medicine?	:	No Yes
If Yes, please list	:
Current Medications?	:	No Yes
Home Phone #2	:
Work Phone #2	:
If Yes, please list medications	:
Any medical conditions we should be aware of?	:	No Yes
If yes, please explain	:
Emergency Contact Name	:
Emergency Contact Phone	:
Emergency Contact #2 Name	:
Emergency Contact #2 Phone	:
Child Lives With (Check all that apply)	:	Mother Father Grandmother Grandfather Relative Guardian(s) Non-Relative Guardian(s) Sibling(s)
Household Size (Include ALL household member)	:
Annual Household Income (please check one)	:
Member's Ethnic Background (please check one)	:
Has your son/daughter been in the juvenile justice system in the past 12 months? (For data collection only)	:
Do you grant permission for images/videos of your child to be used for publicity purposes?	:
I agree with the Emergency Medical Conset (see attached)	:
I agree with the General Waiver for Membership (see attached)	:
I agree with the Parent/Guardian Agreement	:

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