Please complete the form below:

PARENT CONSENT FORM – VIRTUAL CLUBHOUSE

"*" indicates required fields

MM slash DD slash YYYY
Has your child ever attended a Boys & Girls Club of Collier County program?*
Parent Name*
Permission to text
Parent Address*
Parent Employer Address*
Secondary Parent / Guardian Name
Permission to text
Secondary Parent / Guardian Address
Secondary Parent / Guardian Employer Address
Child Name*
Child Gender*
MM slash DD slash YYYY
Child Race*

Child Ethnicity
Parent / Guardian Permission*
Permission to use Zoom*