Join the Boys and Girls Club of the Emerald Coast

2017 Summer Program

As part of our dedication to offering cost-effective after school & summer programming, Boys & Girls Clubs of the Emerald Coast provides a sliding scale rate. Please contact your local Club for more information and membership rates.

Summer Program

Club Member in-take Form

School Information

Parent Contact Information

Emergency Contacts

You must provide 2 Additional Contacts

Medical Information



This information is collected for grant writing and reporting purposes


I hereby make application for my child's membership to the Boys & Girls Clubs of the Emerald Coast I understand that by signing this application my child will be enrolled into the Boys & Girls Clubs Program. A program designed to provide academic, healthy lifestyles, and character/leadership enrichment. It is expressly understood and agreed by the undersigned that the Boys & Girls Clubs of the Emerald Coast is not liable for the loss of property or injury directly resulting from Boys & Girls Clubs of the Emerald Coast negligence or willful act of an employee of the organization. Membership dues will be collected. By signing this application it is also understood that parents must attend a mandatory parent orientation at the beginning of the school year, beginning of the calendar year and at the beginning of the Summer program. I fully understand and agree to all the conditions stated on this form and have counseled my child to confirm to these rules and the authority of the employees of the Boys & Girls Clubs of the Emerald Coast.
Please Type in Your Full Name

Additional Information

The Boys & Girls Clubs of the Emerald Coast serves Members ages 5-18 who have started kindergarten and have not finished twelfth grade.
Children must have begun the first day of kindergarten to be eligible to attend our program, and thus – we do not accept children in the summer before kindergarten.

Stop by any of our Clubs to pick up a Membership Application. It cannot be completed online. You must print, complete and sign the application and bring it with the required documents for each child to your Club or our headquarters location at 923 Denton Blvd., NW Fort Walton Beach, FL 32547.

Questions may be addressed to our club staff at 850.862.1616.



The Boys & Girls Club offers transportation during the academic year to and from several area schools. Some schools provide bus routes directly to our Clubs. Each of our Clubs coordinates parental permission for transportation. Please contact your Club or your school administrator for more information.

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