Adolescent Clubhouse Membership Form-Club F.E.A.R (Face Everything And Rise)
Thank you for considering enrolling your student(s) into the Adolescent Clubhouse-Club F.E.A.R (Face Everything And Rise). Club F.E.A.R works with youth 12-17 years of age and provides preventative opportunities for youth and families in Worcester County. 
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Email *
Member Name
Date of Application
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Address
Race
Gender
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Date of Birth/Age
Name of Current School and Grade
Is the applicant currently attending school?
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What is the students current living arrangement? (Ex. Parent's home, Grandparents, Caregiver, Foster Home)
What is the reason for enrolling the student into the program? (substance use, social skills)
Name of Person Completing the Form/Relationship to member
Parent/Guardian Phone Number and Email
Consent: By signing below, you are granting permission for a Program Director of Club F.E.A.R to enroll your child into the program. You are consenting for your child to participate in Club F.E.A.R programs, activities, and workshops. A staff member from the Adolescent Clubhouse will contact you within 48 hours during business hours.
Consent: Do you agree to have your child photographed and posted on social media platforms and in print media (newspapers. magazines)
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