DFCA Member Application – Payment - Drug Free Clubs of America

All Consent Fields Must Be Checked

Check the 2 boxes in the Consent area below then click Submit

DFCA Consent

I consent to the taking of specimens for drug screening as part of an examination in connection with enrollment into Drug Free Clubs of America (DFCA), and authorize the release of those results to DFCA and my parent or guardian. I also consent to the taking of, or school's release of my (or my child's) photograph, image and/or likeness to be used by and for program related purposes. *

Yes, I am the student applying and I consent.

Parent/Guardian authorization for consent verbiage above. *

Yes, I am the parent/legal guardian of the student applying and I consent -OR- permission from this parent/legal guardian is on file with the school.

Confirm Membership

Student Information:

Name:

Birthdate:

Homeroom #: n\a

School:

Graduation Year:

Gender:

Email:

Address:

Street:

City:

State:

Zip:

Parent/Guardian Information:

Name:

Email:

Phone:

Best Parent #:

Best Student #:

Membership Information:

Selected:

Cost: Free