Bandy Bear Club Membership Application
The Bandy Bear Membership must be signed by a parent.
Please print this form and mail to:
Bandy Bear Membership
759 Chestnut Street
Springfield, MA 01199

When Bandy was just a cub, he came down with the dreaded weasel-pox and had to spend a night at the Children's Hospital. He liked the people and the care he received so much, he promised to come back when he grew up to help take care of kids. Well now he's back, and things at the Children's Hospital will never be the same! Bandy has formed a club to keep children happy and healthy and he'd like your child to become a member. Here are a few of the things your child will receive as a Bandy Bear Club member:

- Child's Name
Male
Female
- Street Address
- City
- State/Province
- ZIP/Postal Code
- Todays Date
- Birthday

In case of Emergency contact:
- Contact Person
- Relationship
- Daytime Phone
- Nightime Phone

- Parent's Name
- Parent's Signature