Leo Club Membership

Alpha Application
Both pages of this form must be completed for all Leos under the legal age of majority and returned to the Leo club advisor who is a
member of the sponsoring Lions club. Because it is the responsibility of the sponsoring Lions club to maintain records on parental/
guardian consent for any young person under the legal age of majority who joins a Leo club, it is imperative that this completed form
be kept on file with the sponsoring Lions club. Completed forms should not be sent to International Headquarters.

Section I: Applicant information

First (Given) Name Middle Name Last (Family) Name

Street Address City State Postal Code Country

Phone Email

Gender Date of Birth (MM/DD/YY)
I am a: New Member Transfer Member Former Member

Previous Club Name (if applicable) Previous Club Number

How did you hear about the Leo club?

Section II: Applicant Signature

I, the undersigned, am in good standing in my school and/or community, and in accordance with the constitution and bylaws
of this club, hereby apply for membership in the Leo Club, sponsored by the
Lions Club. I believe the above information to be true and complete, and I desire
membership in this club. I believe I can make a contribution to the club and be worthy of the friendship of its members. My
parent(s)/guardian(s) and I understand that the entrance fee will be and the annual
dues will be . I also understand that, pending parental/guardian consent, my
personal data will be entered into Lions Clubs International member databases and used to personalize and improve my membership
experience. To understand how LCI uses your personal data, visit www.lionsclubs.org and search the phrase “Your Privacy”.

Signature of Applicant Date

Please complete both sides of this form.

Section III: For Lions use only
Copy of completed application added to Leo club’s files Leo added to club roster via MyLCI (if applicable)
Parental/Guardian consent received Parental/ Guardian consent approved via MyLCI (if applicable)

APPROVED BY

Leo Club Advisor Signature Date

Section IV: Parental/Guardian review and consent

I hereby give permission for my child to become a member of the above-named Leo club. I understand that a Leo club is sponsored
by a local Lions club and provides young people with an opportunity to develop their leadership skills while serving the community. I
have been provided with materials relevant to this Leo club’s operations including the name and contact information of the Leo club
advisor, meeting locations and times, types of service projects conducted, etc.
I understand that by participating in this Leo club, my child will be required to attend club meetings and club service projects, and
may also be asked to participate in club social events. Such meetings, projects and events may sometimes require transportation to
various locations which may at times be provided by the sponsoring Lions club; in other cases, I may be asked to provide or arrange
transportation for my child to attend these meetings, projects and events. Furthermore, I understand that by participating in this
Leo club, my child may be filmed or photographed at various club meetings, projects and events. In addition, I understand that my
child’s personal data will be provided to the sponsoring Lions club and to Lions Clubs International (LCI) headquarters to facilitate
communications with and between our members. This information is to be used solely to further LCI’s Purposes including “to unite
the clubs in bonds of friendship, good fellowship and mutual understanding” and to conduct its necessary operational activities
in accordance with the LCI privacy policy. To understand how LCI uses the personal data of its members, you may visit www.
lionsclubs.org and search the phrase “Your Privacy”.
Please check the appropriate boxes below to indicate the items to which you consent:
I grant permission for my child to be transported to Leo club meetings, projects or events by the Leo club advisor or a member of the sponsoring
Lions club.

I grant permission for my child to be filmed and/or photographed at Leo/Lions events and meetings, and for these videos and/or images to be
posted on the Lions Clubs International public website at www.lionsclubs.org, the Lions Clubs International members-only site (MyLCI), other LCI
member databases, and other Leo/Lion websites at the club, district and multiple district levels.

I grant permission for my child’s personal data to be entered into Lions Clubs International member databases and to be used to facilitate
communications with and between LCI members.

By signing below, you indicate that you have read the information outlined in this form, that you agree to your child’s participation
in the Leo club, and that you consent to the items you have checked above. This signed form should be submitted to the Leo club
advisor and a copy retained for your own records.

Child’s Name Parent or Guardian’s Name

E-mail Phone

Signature of Parent or Guardian Date

Important note to sponsoring lions club

It is the responsibility of the sponsoring Lions club to maintain records on parental/guardian consent for any young person under the legal
age of majority who joins your Leo club. This form should be reviewed and completed by the parent or guardian for members under the
legal age of majority. Please note that if using MyLCI, you will be asked to confirm that your Lions club has received parental/guardian
consent to enter data of any Leos under the legal age of majority. If your club did not obtain parental/guardian consent of a Leo member
who is below the legal age of majority or otherwise is not able to provide legal consent, you must not share their information with LCI.

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