Membership Sign-Up Membership Sign-Up 2 Name * First Name Last Name Email * Thank you! Field Trip Form Media Release & Consent Form Media Release & Consent Form 2 Media Release and General Consent By my signature below, I give permission to the Boys & Girls Club of Moultrie/Colquitt County to allow my son/daughter to participate in the activities indicated below: Public Relations and other media opportunities (photographs) Field Trips Pre + Post Test Surveys Abstinence Programs (Drug, Alchol, Tobacco) Sports, Fitness and Recreation Programs Tracking Academic Progress from Report Cards Allow school to release academic information to the Boys & GIrls Clubs of Moultrie/Colquitt All of the Above Only those with a check mark Printed Signature * First Name Last Name Date MM DD YYYY Member / Name of Child * First Name Last Name Date MM DD YYYY Thank you! Internet Terms of Use Agreement Membership Insurance Coverage DFCS Income Eligibility Parent Handbook
