This document is a new membership application for the Hialeah Gardens Key Club for the 2012-2013 year. It requests contact information, the applicant's schedule and GPA, involvement in other organizations, honors received, and availability to participate in Key Club activities. The applicant must pledge to uphold the Key Club objectives and sign a membership contract agreeing to requirements such as monthly service hours and fundraising participation. For prospective senior members, there is an additional agreement to complete hours through December. The final section is for office use to track the application process.

1. Hialeah Gardens Key Club
New 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: ____________________________________
UnweightedGPA: _____________________________________
Class of: ______2013 _____2014 _____2015______ 2016
*Check in front of graduating year.
Schedule
Period Subject Teacher Room #
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2. Hialeah Gardens Key Club
Section 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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3. Hialeah Gardens Key Club
Are you able to attend our weekly lunch
meetings?
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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4. Hialeah Gardens Key Club
Section 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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5. 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 a30 hourprobation period with
Key Club before October 1stto become a member.
X_______________________________________________________________
Prospective Senior Signature
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6. 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:
_____________________________________________________________________________________________
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