Apply for Membership – Drug Free Clubs of America

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 Name*

First Last

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

Select School*

Select Your Membership for A-Tech*

2 Year - $40

Select Your Membership for Adena*

1 Year - $10

Select Your Membership for ACE*

1 Year - $35

Select Your Membership for Ashland County - West Holmes CC*

1 Year - $20

Select Your Membership for Auburn Career Center*

1 Year - Free
2 Year - Free

Select Your Membership for Barberton High School*

1 Year - Free

Select Your Membership for Bioscience Center*

1 Year - $35
2 Year - $70

Select Your Membership for Canal Winchester*

1 Year - $20

Select Your Membership for Chillicothe High School*

1 Year - Free

Select Your Membership for Circleville*

1 Year - $15

Select Your Membership for Conner*

1 Year - $35

Select Your Membership for Cooper*

1 Year - $35

Select Your Membership for Cuyahoga Falls*

1 Year - $15

Select Your Membership for East Central High School*

1 Year - $25

Select Your Membership for Beechwood High School*

1 Year - $35

Select Your Membership for Boone*

1 Year - $35

Select Your Membership for Bishop Brossart High School*

1 Year - $35
2 Year - $70
3 Year - $105
4 Year - $105

Select Your Membership for Campbell County High School*

1 Year - $35
2 Year - $70
3 Year - $105
4 Year - $105

Select Your Membership for Covington Catholic High School*

1 Year - $25
2 Year - $50
3 Year - $75

Select Your Membership for Dayton High School*

1 Year - $10

Select Your Membership for Dixie Heights High School*

1 Year - $35
2 Year - $70
3 Year - $105
4 Year - $105

Select Your Membership for Grant Career Center*

1 Year - $20
2 Year - $20

Select Your Membership for Hillsdale*

1 Year - $20

Select Your Membership for Holy Cross High School*

1 Year - $35
2 Year - $70
3 Year - $105
4 Year - $105

Select Your Membership for Hudson High School*

1 Year - $20

Select Your Membership for Huntington Local*

1 Year - $10

Select Your Membership for Mahoning CTC*

1 Year - $20

Select Your Membership for Notre Dame Academy High School*

1 Year - $25
2 Year - $50
3 Year - $75
4 Year - $75

Select Your Membership for Turkey Foot Middle School*

1 Year - $35
2 Year - $70
3 Year - $105

Select Your Membership for Bridgeport High School*

1 Year - Free

Select Your Membership for The Linsly School*

1 Year - $20
2 Year - $40
3 Year - $60
4 Year - $60

Select Your Membership for Paint Valley*

1 Year - $10

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

Select Your Membership for Pickerington Central*

1 Year - $20

Select Your Membership for Pickerington North*

1 Year - $20

Select Your Membership for Ryle*

1 Year - $35

Select Your Membership for Sentinel*

1 Year - $15

Select Your Membership for Southeastern*

1 Year - $10

Select Your Membership for Triadelphia Middle School*

1 Year - $20
2 Year - $40
3 Year - $60

Select Your Membership for Unioto*

1 Year - $10

Select Your Membership for Vanguard*

1 Year - $15

Select Your Membership for Watkins Memorial*

1 year - $67 (Full program year price. THANK YOU!)
1 Year - $20 (Discounted)

Select Your Membership for Wayne County Schools Career Center*

1 Year - $10

Select Your Membership for Wheeling Central Catholic*

1 Year - $20
2 Year - $40
3 Year - $60
4 Year - $60

Select Your Membership for Wheeling Park High School*

1 Year - $20
2 Year - $40
3 Year - $60
4 Year - $60

Select Your Membership for Wooster High School*

1 Year - FREE

Select Your Membership for Zane Trace*

1 Year - $10

Grade*

Student Birthdate*

Gender*

Homeroom Number (If Known)

Have you been a member before?*

Yes
No

Address*

Street Address Address Line 2 City State ZIP Code

Best Phone*

Parent Cell*

Student Cell*

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.

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