Junior Application | JeffersonGrange#1384

You Belong!

Children ages 5-13 are welcome to apply with the help and permission of their parents/guardians. All Juniors applicants are accepted, so you may choose to pay your application fee and dues immediately or defer your dues until your first meeting.

Junior Applicant's Name

Street Address, City, State, Zip

Date of Birth

Do you have (an) additional child(ren) age 5-13 you wish to enroll in the Junior Grange?

Please enter the name and date of birth of each additional child here.

Name of Parent(s)/Guardian(s)

Parent/Guardian Email

Parent/Guardian Phone

I respectfully petition to enroll my child/children listed above as (a) member(s) of Jefferson Grange #1384 Junior program and hereby give my child(ren) permission to participate in Grange activities.

I understand photos of my child(ren) may appear on Jefferson Grange #1384's website or social media unless I explicitly decline such participation in written communication to the Secretary of Jefferson Grange #1394.

I understand I will receive emails from Jefferson Grange #1384 about Junior and general Grange events, updates and more. I may request to be removed from all non-Junior Grange related email or request to add my child's email or the email of other authorized parents/guardians to the distribution list by contacting the Secretary of Jefferson Grange #1384.

Parent/Guardian Signature