Apply for Membership – Drug Free Clubs of America

Apply for DFCA Membership
Important Note: This form will not work in the Microsoft Explorer browser as Microsoft discontinued supporting that browser and security cannot be ensured. We are so glad you're applying! In the event that you get an ERROR message, please click the red "verify" button below to see all boxes. The one with the error will be highlighted. Please be sure EVERY box is filled in. Pay special attention to the phone numbers and the check boxes toward the bottom. Thank you! Special question or persistent problem? Please email us at heatherm@drugfreeclubs.com.

Have you been a member before?*
Yes
No
Student Name*
First Last
Student Birthdate*

Select School*
Parent Name*
First Last
BEST Parent Email (A valid email is extremely important for communications which are often time-sensitive.. DFCA will never sell your information.)*

Student Email (DO NOT USE SCHOOL EMAIL unless no other email exists so DFCA does not overburden the school's email system)*

Grade*
Gender*
Homeroom Number (If Known)
Address*
Street Address City State ZIP Code

Best Phone*
Parent Cell*
Student Cell*
Select Your Membership for Adena*
1 Year - $10 (+3% fee sent directly to credit card company)
FREE Membership-I'm a M.A.D.E. Ambassador
Select Your Membership for Auburn Career Center*
1 Year - Free
Select Your Membership for Home Office*
1 Year - Free
2 Year - Free
Select Your Membership for Barberton High School*
1 Year - $20 (+3% sent directly to credit card company)
Select Your Membership for Beechwood High School*
1 Year - $35 (+3% fee sent directly to credit card company)
2 Years - $70 (+3% fee sent directly to credit card company)
3 Years - $105 (+3% fee sent directly to credit card company)
4 Years - Get Sr. year FREE! $105 (+3% fee sent directly to credit card company)
Select Your Membership for Bishop Brossart High School*
1 Year - $35 (+3% fee sent directly to credit card company)
2 Year - $70 (+3% fee sent directly to credit card company)
3 Year - $105 (+3% fee sent directly to credit card company)
4 Year - $105 (+3% fee sent directly to credit card company)
Select Your Membership for Boone*
1 Year - $35 (+3% sent directly to credit card company)
Select Your Membership for Bridge Street*
1 Year - $20 (+3% fee sent directly to credit card company)
2 Year - $40 (+3% fee sent directly to credit card company)
3 Year - $60 (+3% fee sent directly to credit card company)
Select Your Membership for Buckeye Career Center*
1 Year - $20 (+3% sent directly to credit card company)
Select Your Membership for Buckeye Hills CC*
1 Year - Free
Select Your Membership for Buckeye Hills ADULT ED*
1 Year - Free
Select Your Membership for Camp Ernst*
1 Year - $35 (+3% fee sent directly to credit card company)
Select Your Membership for Campbell County High School*
1 Year - $35 (+3% fee sent directly to credit card company)
2 Year - $70 (+3% fee sent directly to credit card company)
3 Year - $105 (+3% fee sent directly to credit card company)
4 Year - $105 (+3% fee sent directly to credit card company)
Select Your Membership for Canal Winchester*
1 Year - $20 (+3% fee sent directly to credit card company)
Select Your Membership for Circleville*
1 Year - $20 (+3% fee sent directly to credit card company)
Select Your Membership for Conner*
1 Year - $35 (+3% fee sent directly to credit card company)
Select Your Membership for Cooper*
1 Year - $35 (+3% fee sent directly to credit card company)
Select Your Membership for Covington Catholic High School*
1 Year - Free
Select Your Membership for Dayton*
1 Year - Free
Select Your Membership for Dixie Heights High School*
1 Year - $35 (+3% fee sent directly to credit card company)
2 Year - $70 (+3% fee sent directly to credit card company)
3 Year - $105 (+3% fee sent directly to credit card company)
4 Year - $105 (+3% fee sent directly to credit card company)
Select Your Membership for Fostoria*
1 Year - Free
Select Your Membership for Four County Career Center*
1 Year - $10 (+3% fee sent directly to credit card company)
Select Your Membership for Holy Cross High School*
1 Year - $35 (+3% fee sent directly to credit card company)
2 Year - $70 (+3% fee sent directly to credit card company)
3 Year - $105 (+3% fee sent directly to credit card company)
4 Year - $105 (+3% fee sent directly to credit card company)
Select Your Membership for Hudson High School*
1 Year - $20 (Discounted) (+3% fee sent directly to credit card company)
1 Year - $67 (Full program price. THANK YOU! (+3% fee sent directly to credit card company))
There is a flat fee per student of $67 for a year of the full DFCA program. Generous donor contributions allow us to offer a discounted option of $20. Please choose one of the options above.
Select Your Membership for Huntington Local*
1 Year - $10 (+3% fee sent directly to credit card company)
FREE Membership-I'm a M.A.D.E. Ambassador
Select Your Membership for Lakeside*
1 Year - Free
Select Your Membership for The Linsly School*
1 Year - $20 (+3% fee sent directly to credit card company)
2 Year - $40 (+3% fee sent directly to credit card company)
3 Year - $60 (+3% fee sent directly to credit card company)
4 Year - $60 (+3% fee sent directly to credit card company)
Select Your Membership for Logan*
1 Year - $20 (+3% sent directly to credit card company)
Select Your Membership for Ludlow High School*
1 Year - $35 (+3% fee sent directly to credit card company)
Select Your Membership for Mahoning CTC*
1 Year - Free
Select Your Membership for McClain HS*
1 Year - $20 (+3% fee sent directly to credit card company)
Select Your Membership for Mid-East Buffalo*
1 Year - FREE!
The full cost of a year of DFCA membership is typically $67, but thanks to Mid-East CTC your membership is FREE!
Select Your Membership for Mid-East Zanesville*
1 Year - FREE!
The full cost of a year of DFCA membership is typically $67, but thanks to Mid-East CTC your membership is FREE!
Select Your Membership for Mount Notre Dame*
1 Year - $35 (+3% fee sent directly to credit card company)
Select Your Membership for Norwalk High School*
1 Year - $10 (+3% fee sent directly to credit card company)
Select Your Membership for Norwalk Middle School*
1 Year - $10 (+3% fee sent directly to credit card company)
Select Your Membership for Oak Hill*
1 Year - FREE
Select Your Membership for Notre Dame Academy High School*
1 Year - $25 (+3% fee sent directly to credit card company)
2 Year - $50 (+3% fee sent directly to credit card company)
3 Year - $75 (+3% fee sent directly to credit card company)
4 Year - $75 (+3% fee sent directly to credit card company)
Select Your Membership for Paint Valley*
1 Year - $10 (+3% fee sent directly to credit card company)
FREE Membership-I'm a M.A.D.E. Ambassador
Select Your Membership for Parkersburg High School*
1 Year - $20
Select Your Membership for Parkersburg South*
1 Year - $20
Select Your Membership for Pickaway Ross Career & Technology Center*
1 Year - $10 (+3% fee sent directly to credit card company)
FREE Membership-I'm a M.A.D.E. Ambassador
Select Your Membership for Pickerington Central*
1 Year - $25 (+3% fee sent directly to credit card company)
Select Your Membership for Pickerington North*
1 Year - $25 (+3% fee sent directly to credit card company)
Select Your Membership for Ross County Christian Academy*
1 Year - $10 (+3% fee sent directly to credit card company)
FREE Membership-I'm a M.A.D.E. Ambassador
Select Your Membership for Ryle*
1 Year - $35 (+3% fee sent directly to credit card company)
Select Your Membership for RA Jones*
1 Year - $35 (+3% fee sent directly to credit card company)
Select Your Membership for Saint Henry*
1 Year - $35 (+3% fee sent directly to credit card company)
1 Teacher Membership - $10 (+3% sent directly to credit card company)
Select Your Membership for Saint Paul*
1 Year - $10 (+3% fee sent directly to credit card company)
Select Your Membership for Scioto County CTC*
1 Year - $20 (+3% fee sent directly to credit card company)
Select Your Membership for Sentinel*
1 Year - $15 (+3% fee sent directly to credit card company)
Select Your Membership for South Webster*
1 Year - $67 (+3% fee sent directly to credit card company)
Select Your Membership for Southeastern*
1 Year - $10 (+3% fee sent directly to credit card company)
FREE Membership-I'm a M.A.D.E. Ambassador
Select Your Membership for Southern Hills*
1 Year - $10 (+3% fee sent directly to credit card company)
Select Your Membership for Springfield Clark CTC*
1 Year on credit card - $10 (+3% fee sent directly to credit card company)
1 Year-I will pay $10 to a DFCA advisor at school
STUDENT OFFICER
Select Your Membership for Teays Valley*
1 Year - $20 (+3% fee sent directly to credit card company)
Select Your Membership for Triadelphia Middle School*
1 Year - $20 (+3% fee sent directly to credit card company)
Select Your Membership for Turkey Foot Middle School*
1 Year - $35 (+3% fee sent directly to credit card company)
2 Year - $70 (+3% fee sent directly to credit card company)
3 Year - $105 (+3% fee sent directly to credit card company)
Select Your Membership for Unioto*
1 Year - $10 (+3% fee sent directly to credit card company)
FREE Membership-I'm a M.A.D.E. Ambassador
Select Your Membership for Vanguard*
1 Year - $15 (+3% fee sent directly to credit card company)
Select Your Membership for Vantage Career Center*
1 Year - $20 (+3% fee sent directly to credit card company)
Select Your Membership for Watkins Memorial*
1 year - $67 (Full program year price. THANK YOU!) (+3% fee sent directly to credit card company)
1 Year - $20 (Discounted) (+3% fee sent directly to credit card company)
There is a flat fee per student of $67 for a year of the full DFCA program. Generous donor contributions allow us to offer a discounted option of $20. Please choose one of the options above.
Select Your Membership for Watkins Middle School*
1 year - $67 (Full program year price. THANK YOU!) (+3% fee sent directly to credit card company)
1 Year - $20 (Discounted) (+3% fee sent directly to credit card company)
There is a flat fee per student of $67 for a year of the full DFCA program. Generous donor contributions allow us to offer a discounted option of $20. Please choose one of the options above.
Select Your Membership for Wayne County Schools Career Center*
1 Year - $10 (+3% fee sent directly to credit card company)
Select Your Membership for Westfall*
1 Year - FREE
Select Your Membership for Wheeling Central Catholic*
1 Year - $20 (+3% fee sent directly to credit card company)
2 Year - $40 (+3% fee sent directly to credit card company)
3 Year - $60 (+3% fee sent directly to credit card company)
4 Year - $60 (+3% fee sent directly to credit card company)
Select Your Membership for Wheeling Park High School*
1 Year - $20 (+3% fee sent directly to credit card company)
2 Year - $40 (+3% fee sent directly to credit card company)
3 Year - $60 (+3% fee sent directly to credit card company)
4 Year - $60 (+3% fee sent directly to credit card company)
Select Your Membership for Zane Trace Test*
1 Year - $10 (+3% fee sent directly to credit card company)
FREE Membership-I'm a M.A.D.E. Ambassador
Select Your Membership for Zane Trace*
1 Year - $10 (+3% fee sent directly to credit card company)
FREE Membership-I'm a M.A.D.E. Ambassador
Student Photo
Accepted file types: jpg, png, jpeg.
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 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.
Photograph/video consent: I consent to the taking of, or the school’s release of, my (or my child’s) photograph, image, and/or likeness to be used by and for DFCA’s purposes. (ALL BOXES MUST BE CHECKED)
Yes, I am the student applying and I consent.
Parent authorization for photo/video consent verbiage above
Yes, I am the parent/legal guardian of the student applying and I consent.
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Total
$0.00

Following this application process, students will register for their membership and take their test on their school’s chosen “DFCA launch day”. Club acceptance and ongoing participation is dependent upon students producing drug-free test results at any time upon DFCA’s request. All fees are non-refundable upon the start of launch day.