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  • Youth Membership Application

    Confidentiality. Any confidential information requested is for our records and for the funding our organization receives. The answers you provide will be kept completely confidential. Your cooperation in providing this information is both appreciated and necessary. Required fields are denoted with and asterisks (*)
  • Member Information

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  • Member Medical Information

  • Medical Consent Statement

    I hereby consent to any medical care and the administration of anesthesia determined by a physician to be necessary for the welfare of my child, listed on this application, while said child is under the care of the West Cook County Youth Club.

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  • Parent/Guardian Information

  • Parent/Guardian #1

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  • Parent/Guardian #2

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  • Emergency Contacts

    Please list the details for any additional emergency contacts besides the parent/guardian listed above.
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  • Household Information

  • Membership Rules

  • Click Here to read Parent/Member Handbook

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  • After you submit your application, please ensure you make your payment at this website: www.wccyouthclub.com/become-a-member.

    Thank you!

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