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Leo 50

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92 views

Leo 50

Uploaded by

api-243551225
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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ALPHA APPLICATION FOR LEO CLUB MEMBERSHIP

Both pages of this form must be completed for all Leos under the legal age of majority and returned to the Leo club advisor who is a member of the sponsoring Lions club. Because it is the responsibility of the sponsoring Lions club to maintain records on parental/guardian consent for any young person under the legal age of majority who joins a Leo club, it is imperative that this completed form be kept on file with the sponsoring Lions club. Completed forms should not be sent to International Headquarters.

SECTION I: APPLICANT INFORMATION


First (Given) Name Last (Family) Name Street Address City Country Preferred Phone Gender Other organizations of which I am a member I am a: New Member Transfer Member Previous Club Name How did you hear about the Leo club? Former Member Member Number
(If unknown, e-mail [email protected])

Middle Name

State

Postal Code

E-mail Year of Birth

Previous Club Number

SECTION II: APPLICANT SIGNATURE


I, the undersigned, am in good standing in my school and/or community, and in accordance with the constitution and bylaws of this club, hereby apply for membership in the sponsored by the Leo Club, Lions Club. I believe the above information to be true

and complete, and I desire membership in this club. I believe I can make a contribution to the club and be worthy of the friendship of its members. My parent(s)/guardian(s) and I understand that the entrance fee will be __________ and the annual dues will be . I also understand that, pending parental/guardian consent, my personal data will be entered into Lions Clubs International member databases and used to facilitate communications with and between LCI members. Parental/guardian consent section can be found on the second page of this form.

SIGNATURE OF APPLICANT

DATE

SECTION III: FOR LIONS USE ONLY


Copy of completed application added to Leo clubs files Parental/Guardian consent received APPROVED BY
Leo Club Advisor Signature

Leo added to club roster via MyLCI Parental/ Guardian consent approved via MyLCI DATE

Leo-50A 1/13

Please complete both sides of this form

SECTION IV: PARENTAL/GUARDIAN REVIEW AND CONSENT


I hereby give permission for my child to become a member of the above-named Leo club. I understand that a Leo club is sponsored by a local Lions club and provides young people with an opportunity to develop their leadership skills while serving the community. I have been provided with materials relevant to this Leo clubs operations including the name and contact information of the Leo club advisor, meeting locations and times, types of service projects conducted, etc. I understand that by participating in this Leo club, my child will be required to attend club meetings and club service proje cts, and may also be asked to participate in club social events. Such meetings, projects and events may sometimes require transportation to various locations which may at times be provided by the sponsoring Lions club; in other cases, I may be asked to provide or arrange transportation for my child to attend these meetings, projects and events. Furthermore, I understand that by participating in this Leo club, my child may be filmed or photographed at various club meetings, projects and events. In addition, I understand that my childs personal data will be provided to the sponsoring Lions club and to Lio ns Clubs International (LCI) headquarters to facilitate communications with and between our members. This information i s to be used solely to further LCIs Purposes including to unite the clubs in bonds of friendship, good fellowship and mutual understanding and to conduct its necessary operational activities in accordance with the LCI privacy policy. To view the LCI privacy policy, you may visit www.lionsclubs.org and enter the phrase Privacy Policy in the search box at the upper righthand corner of the home page. Please check the appropriate boxes below to indicate the items to which you consent: I grant permission for my child to be transported to Leo club meetings, projects or events by the Leo club advisor or a member of the sponsoring Lions club. I grant permission for my child to be filmed and/or photographed at Leo/Lions club events and meetings, and for these videos and/or images to be posted on the Lions Clubs International public website at www.lionsclubs.org, the Lions Clubs International members-only Intranet site (MyLCI), other LCI member databases, the Leo clubs website, and/or the Lions clubs/districts website. I grant permission for my childs personal data to be entered into Lions Clubs International member databases and to be used to facilitate communications with and between LCI members. By signing below, you indicate that you have read the information outlined in this Leo -50 form, that you agree to your childs participation in the Leo club, and that you consent to the items you have checked a bove. This signed form should be submitted to the Leo club advisor and a copy retained for your own records.

Childs Name Parent or Guardians Name Street Address State or Province_ E-mail Signature of Parent or Guardian Country City Postal Code Preferred Phone Date

IMPORTANT NOTE TO SPONSORING LIONS CLUB:


It is the responsibility of the sponsoring Lions club to maintain records on parental/guardian consent for any young person under the legal age of majority who joins your Leo club. This form should be reviewed and completed by the parent or guardian for members under the legal age of majority. Please note that when using MyLCI, you will be asked to confirm that your Lions club has received parental/guardian consent to enter data of any Leos under the legal age of majority.
Leo-50A 1/13

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