Name: BTC Outdoors
Start: 2020-10-31T10:00:00-04:00
End: 2020-10-31T13:00:00-04:00
Location: Brookline Teen Center

BTC Membership Online Application
This form will take approximately 10-15 minutes to complete and should be completed with a parent present.

Thank you for using the BTC Online Membership Application!

Please click "Next" to begin!

Member/Teen Information
Member Name*
First Last
Member Home Address*
Street Address Address Line 2 City State ZIP Code
Member/Teen Date of Birth*
Current School*
Other School Name
HIGH SCHOOL Graduation Year*
Please enter the expected High School date of graduation,
NOT Middle or Elementary School graduation. Graduation Year Calculator
Other Current Grade
Member/Teen Email*
This should NOT be the same as the Parent/Guardian email.
Member/Teen Cell
Not required, but strongly advised to include.
Gender*
Other Gender
Race/Ethnicity
Number of People Living in Household
Number of Siblings

Parent/Guardian 1
Parent 1: Name*
First Last
Parent 1: Home Address*
Same as Member

Street Address Address Line 2 City State ZIP Code
Parent 1: Home Phone
Parent 1: Cell Phone*
Parent 1: Work Phone
Parent 1: Email*
Parent 1: Occupation
Parent 1: Employer
Parent/Guardian 2
(If applicable)
Parent 2: Name
First Last
Parent 2: Home Address
Same as Member

Street Address Address Line 2 City State ZIP Code
Parent 2: Home Phone
Parent 2: Cell Phone
Parent 2: Work Phone
Parent 2: Email
Parent 2: Occupation
Parent 2: Employer

Emergency Contact 1
EContact 1 Name*
First Last
EContact 1 Address
Street Address Address Line 2 City State ZIP Code
EContact 1 Relationship to Member*
EContact 1 Home Phone
EContact 1 Cell Phone*
EContact 1 Work Phone
Emergency Contact 2
(Optional)
EContact 2 Name
First Last
EContact 2 Address
Street Address Address Line 2 City State ZIP Code
EContact 2 Relationship to Member
EContact 2 Home Phone
EContact 2 Cell Phone
EContact 2 Work Phone

Payment
The BTC is a privately funded, non-profit organization, with no public or town funding. We partially rely on memberships to provide our excellent programs, activities, and opportunities to Brookline's youth.

The annual membership fee is $200.

However, we understand that our members come from a wide spectrum of financial positions. If this fee does not fit your budget, we would like to work with you to make the Teen Center accessible. Please contact us at info@brooklineteencenter.org for more information.
Membership Plans
Payments can be made Annually, Bi-Annually or Monthly. Membership can be cancelled at any time and future payments will not be owed. There are no refunds once a payment has been made.

Please select from the following options to find the payment terms that work best for you.
Recommended Payment Options
- An annual amount of $200 fits my budget
- A bi-annual amount of $100 fits my budget
- An monthly amount of $18 fits my budget
Did you find a payment option that worked for you?
- No, I'm unable to afford any of the above payment options.
Get Involved!
- Yes, I am interested in finding out ways I can help to support the BTC.
Total Due Today:
$0.00
Parent Responsible for Payment?*
If paying by Credit Card, the selected Parent addresses must match billing address.

Payment Details
Total Due Today:
$0.00
I would like to pay:
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Terms & Conditions
The application is factual and complete to the best of my ability. I understand that participation is contingent upon acknowledging receipt of BTC’s Member and Parent Handbook.

All information in this form is confidential and will only be seen by specifically-designated adult staff. This information is essential for BTC funding purposes and to assist in better serving your child, I give my consent for photographs, audiotapes and video records of my son/daughter to be used for BTC for publicity purposes. I also agree to allow BTC to use photographs, audiotapes, video records or other work produced by my son/daughter for publicity purposes.

In the event of injury or should emergency care be requires and I cannot be reached, I authorize staff from BTC to sign for emergency medical attention for my child.

By accepting below, it is understood that the code of conduct will be adhered to. Failure to comply with the center rules and expectations can lead to termination of membership.

In enrolling my child as a member of BTC, I understand that my child assumes any and all risks which might be associated with its activities and waive and release all rights and claims for the damages which my child, heirs, executors, administrators, assigns or I may have against BTC, it’s directors, staff or representatives for any and all injuries or damages of any kind suffered as a result of participation in the membership of BTC.

I agree to comply with and abide by the MINDBODY Terms of Service.
Acceptance:*
- I Agree to the Terms and Conditions
Email
This field is for validation purposes and should be left unchanged.

Step 1 of 7

BTC Membership Online Application

Member/Teen Information

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact 1

Emergency Contact 2

Medical Information

Payment

Membership Plans

Payment Details

Terms & Conditions