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Please select what applies
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Financial Aid Is Available:
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MEMBERSHIP STATUS
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Please select the one
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I. CHILD INFORMATION
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CHILD 2 IF NEEDED:
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CHILD 3 IF NEEDED:
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CHILD 4 IF NEEDED:
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II. FAMILY INFORMATION
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2ND PARENT/GUARDIAN
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III. FAMILY INFORMATION
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IV. EMERGENCY CONTACTS
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V. MEDICAL INFORMATION
PLEASE LIST YOUR CHILD(ren)s HEALTH CARE INSURANCE PROVIDER
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PLEASE LIST ALL MEDICATIONS, MEDICAL , SOCIAL CONDITIONS AND RESTRICTIONS.
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VI. PHOTO RELEASE
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VII. REPORT CARD RELEASE
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VIII. SURVEY RELEASE
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DIGITIAL SIGNATURE
In order to conduct certain transactions with the John M. Barry Boys & Gilrs Club of Newton by electronic means, you, or your authorized representative, will be required to use an electronic signature when such signature is necessary. We will ask that you also agree to all terms and conditions presented in an Electronic Application. Please be aware that an electronic signature is as legally binding as a handwritten signature.
The Electronic Signatures Act (Public Law No: 106-229) went into effect on October 1, 2000 and gives electronic contracts the same weight as those executed on paper.
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