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Hialeah Gardens Key ClubNew Membership Application

2012-2013

Section I: Contact Information

Name______________________________________________________________

Student I.D.#____________ Grade:_____ Date of Birth: ___________________

Address:___________________ City/State:_________________Zip Code_______

Cell Phone #:_______________________________

Can you receive text messages? ___yes ___no

Home phone #:_____________________________

Email: ____________________________________

Unweighted GPA: _____________________________________

Class of: ______2013 _____2014 _____2015______ 2016

*Check in front of graduating year.

SchedulePeriod Subject Teacher Room #

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Hialeah Gardens Key ClubSection II: Questionnaire

What organizations do you now belong or have belonged to? Please list any

offices you have held._________________________________________________________________________________________________________________________________________________________________________________________________________Have you received any honors or special achievements? Please list them. _________________________________________________________________________________________________________________________________________________________________________________________________________What out-of-school activities do you currently participate in? _________________________________________________________________________________________________________________________________________________________________________________________________________Why do you want to join Key Club? What can you contribute if you join?_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Hialeah Gardens Key Club

Are you able to attend our weekly lunchmeetings?Yes_________ No_________

Do you have transportation to/from projects and events?

Yes_________ No_________

Do you drive and own a car? Yes____ No____

Would you be able to drive a car pool to some projects? Yes________ No_______

Are you willing to participate in the required monthly fundraiser? Yes___ No____

Are you willing to attend fundraisers for Kiwanis and not receive service hours to contribute to the bettering of the organization? Yes_______ No________

Do you have a friend[s] that would like to join Key Club? [Write first & last name]______________________________________________________________________________________________________________________________________

Did someone invite you to join Key Club? [Is so give his/her full name?]___________________________________________________________________

Section III: Key Club Pledge

I pledge on my honor to uphold the objects of Key Club International; to build my home, school, and community, to serve my nation and God; and to combat all forces that tend to undermine these institutions.

X__________________________________________________________________

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Hialeah Gardens Key ClubSection IV: Membership Contract

As a member of the Key Club of Hialeah Gardens High School, I will attend all meetings and participate in all club activities. I will earn at least 10 community service hours per month, including the summer. I will participate in all required projects, including all fundraising activities, or complete make-up work as approved by the Board of Directors. I will abide by the Key Club pledge and will be a good representative of my club, school, and community. Also, I will complete a 30 hour probation period before October 1, 2012 with Key Club before I’m a member. Failure to abide by these terms will result in probation and ultimately termination from the club.

X__________________________________________________________________

Prospective Member Signature________________________

Date Signed

My son/daughter has my permission to join the Key Club of Hialeah Gardens High School. I will allow my son/daughter to attend lunch meetings on Wednesdays. I understand that my son/daughter will participate in many community service projects on the weekends and—on occasion—during the week. I also understand that he/she will be responsible for participating in fundraising activities to raise money for the club. I further understand that I must participate in at least one peanut day or car wash as a supervisor during this Key Club year. I fully understand that transportation is not provided, I must provide transportation.

X_______________________________________________________________Legal Guardian Signature___________________

Date Signed

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Hialeah Gardens Key Club

Section V: New Prospective Seniors ONLY

*If you are a graduating this year and a returning member to Key Club this does NOT apply to you!

As a senior at Hialeah Gardens High School and a prospective member I understand that I need to complete 10 hours each month even after the service hour cutoff date in December to graduate. As a prospective member of Key Club as a senior I also understand that I must complete a 30 hour probation period with Key Club before October 1st to become a member.

X_______________________________________________________________Prospective Senior Signature

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Section VI: Office Use Only

Date Application Submitted:

_____________________

Date Dues Paid:

_____________________

Grade Point Average:

_____________________

Date Financial Obligations Checked:

_____________________

Results of Financial Obl. Check:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Date of Board Approval:

_____________________

Date of Board Rejection:

_____________________

Reason for Rejection:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Date Inducted:

_____________________

Certificate Presented?

_____________________

Pin Presented?

_____________________

Chair’s Signature:

_____________________________________________________________________________________________