Mathews-Dickey Boys & Girls' Club
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Membership - Apply Online

SPECIAL NOTICE: The Club has unveiled a new program tree including cultural arts & health, educational enrichment, sports & recreation and summer day camp components. To maintain the high standard of service that is our hallmark, the annual membership fee becomes $50 on July 1, 2014.

If you do not wish to fill out our 3 STEP online application and pay online, you can download our Membership Application (.PDF)

STEP 1 - Child's Information
First Name: Age:
Middle Name: Date of Birth:
Last Name: Sex:
Street Address: Birthplace:
  School:
  Grade:
City: Number of Brothers:
State: Number of Sisters:
Zip: Uniform Size:
Home Phone: Work Phone:  Ext:
Fax Number: Email Address:

STEP 2 - Contact & Family Information
Name of Mother or Guardian: Name of Father or Guardian:
Mother/Guardian Employment: Father/Guardian Employment:
Work Phone: Work Phone:
Cell/Pager: Cell/Pager:
Emergency Contact Name: Do you have Medical Insurance?    
Relationship: Insurance Company:
Home Phone: Insurance Company Phone:
Work Phone:    
Family Income Range Ethnic Background

STEP 3 - Areas of Interest
Other:


Please review the following and initial where required.

I give my consent for my child to join the Mathews-Dickey Boys' & Girls' Club of St. Louis. As a member family of Mathews-Dickey, we accept responsibility for the proper care, usage and return of all Mathews- Dickey property, uniforms and equipment. I grant permission for my child to participate in field trips and special events scheduled for members. I understand that all precautions will be taken for the safety and welfare of my child. I will not hold the Mathews-Dickey Boys' & Girls' Club nor its Representatives responsible for any accidents incurred by my child during participation in Club programs. I clearly understood that Membership fees are not refundable, under any circumstances.

By my initials, I agree to the above statement:

After you hit the submit button, you will be directed to the payment page.

Mathews-Dickey Boys' & Girls' Club is a nonprofit 501 (c) (3) United Way member agency that annually provides educational, athletic and cultural enrichment programs to more than 40,000 young people from throughout the St. Louis metropolitan area. Since 1960 the Club has taught youth respect, restraint and responsibility so that they may obtain credibility, integrity and accountability. For more information, call Bill Fronczak at (314) 382-5952, ext. 228.