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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