2022 Summer Camp
MEMBER INFORMATION
The following information is required for membership at Boys & Girls Clubs of Hernando County.
This information will not be used individually but grouped and used for securing and maintaining local, state, and federal funding sources, including donations and grants. All information is held strictly confidential.
Please enter the following information for the Child you are enrolling as a Member of the Boys & Girls Clubs of Hernando County:
SCHOOL INFORMATION FOR 2021-2022 SCHOOL YEAR
MEDICAL INFORMATION
PHYSICAL INFORMATION
HOUSEHOLD INFORMATION
Please note that if there is a court order pertaining to a parent/guardian and contact with a member, you MUST provide a copy of the court order to the Unit Director. We cannot, by law, restrict access to a child by a parent without a valid court order. You may upload a copy of a court order using the upload button below, prior to submitting your application.
Visa®, MasterCard® & Discover® cardholdersYour security code is the 3-digit code at the end of the signature field on your card's back.
American Express® cardholdersYour security code is the 4-digit code located above the actual credit card number on your card's front.