SCS Junior Student YMCA

Membership Form

2008-2009

Student Information

Name of Student

Age                             Birth date                            Grade

Address (Street or P.O. Box)                                  City                             State               Zip

Telephone

Email address

As an eighth grader, are you interested in serving as a Student YMCA officer?                            

Please circle the office below that you are most interested in:

President                               Vice President                                  Secretary

Treasurer                               Chaplain

What other interests do you have, such as clubs, sports, and hobbies?                                         

Student YMCA Pledge

MISSION STATEMENT—Since 1890, the Kentucky YMCA has encouraged the spiritual, intellectual, social, and physical development of young people through community service, government awareness, and leadership training.

As a member of the Student YMCA, I promise to do the following:

-       Attend meetings regularly

-       Participate in club projects and activities

-       Do my part to help make our club a good club

-       Do my best in school

-       Do things which would credit my family, my club, my school, and myself.

Student Signature                                                                    Parent/Guardian Signature

Complete this form and return to Mr. McGuire, September 15-19, along with your annual dues of $15.00.  Please make checks payable to:  SCS Student YMCA