INITIAL SIGN UP APPLICATION

1) Name   __________________________________________________________          2) Age and Birthday __________________


3) Sex      M    or    F               
 

4) Student Contact Info

 

     Address   _______________________________________________________________________________________

     Phone   _____________________________               Email   _____________________________

 

5) Parent/Guardian Info

    

     Name   __________________________________________________________      Relation   _______________________

 

     Addresses (if different than student's)  

     _______________________________________________________________________________________

     Phone   _____________________________               Email   _____________________________

 

    

     Name __________________________________________________________      Relation _______________________

     Addresses (if different than student's)

 

     _______________________________________________________________________________________

 

     Phone _____________________________              Email  _____________________________
 

6.) A quick description of the intended experience or youth program.

 

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

 

7.) One teacher signature/recommendation

Print __________________________________________________________

Sign __________________________________________________________

Class Taught ____________________________________________________

Teacher Comments (optional)  

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

 DO NOT FORGET!! The following are also needed with this form for initial sign up:

*Signed Parent Permission Form

*Signed Obligation Notice of Intent Form

Click here to download The Patched Overalls Application.

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