Virtual Club Registration Page - Boys & Girls Clubs of Central Minnesota

Name of Youth*

First Last

Age*

Gender*

Are you a Club member? If so, which site do you attend?

Do you have a parent in the military?*

Do you have a parent in the military? We are collecting this information to support a partnership with Boys & Girls Clubs of America supporting military families.

Military sponsor first and last name*

First Last

Branch of military*

Status*

Duty station*

Rank*

Distance from home to the nearest Youth Military Center (approximately in miles)?*

Parent/Guardian first and last name*

First Last

Mobile phone number

Your parent's mobile phone

Best email address*

Your parent's email address. We may use this to send out information about live Virtual Club programming events.

I grant permission to share my name and email address with www.Tutor.com to register for their tutoring services as part of my membership benefits.*

Yes - share my information with Tutor.com
No - do not share my information with Tutor.com

I have my parent's permission to visit the Virtual Club*

Please make sure you have your parent's permission to visit the Virtual Club.

By checking here, you are informing the Boys & Girls Clubs of Central Minnesota that you have received parent permission to visit the Virtual Club and participate in virtual programming.

Name

This field is for validation purposes and should be left unchanged.