2024 Membership Registration

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Winter/Spring or Summer Application?
Program Selection

Harriman Base Camp



Program Selection



Are you a New or Current Member?
MEMBER INFORMATION














MEMBER ADDRESS





MEMBER EDUCATION






HOUSEHOLD INFORMATION






HEALTH INFORMATION

Please enter n/a for any health question that isn't applicable












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PRIMARY PARENT/ GUARDIAN INFORMATION





















SECONDARY PARENT/ GUARDIAN INFORMATION




















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Emergency Contact #1









Emergency Contact #2








Additional Person(s) Authorized to Pick-Up Member 









I do hereby give consent to The Boys' Club of New York staff to obtain necessary emergency medical treatment for my child with the understanding that the family will be notified as soon as possible.



I hereby give my permission for photographs and videos of the member, his artwork or other assets created through BCNY to be used in BCNY promotional content and materials, emails, social media, website and any platform of our choosing now and in the future, and in BCNY events, newspaper articles, TV features, online videos, or publications/social media accounts approved by BCNY. I additionally permit his artwork or other assets to be used by BCNY for sale without compensation. I give permission for him to participate in BCNY surveys and interviews for promotional content. I also opt-into BCNY emails, newsletters and communications.

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