Harlem RBI Team Enrichment 2016-2017 Interest Form
Youth Interest form for Grades 6-12
Youth Name
Your answer
Youth Gender
Parent/Guardian Name
Your answer
Parent/Guardian Name Relationship
Your answer
Youth Birth Date
MM
/
DD
/
YYYY
Youth Age
Your answer
School
Your answer
Current Grade
Street Address
Your answer
City, State
Your answer
Zip Code
Your answer
Parent Phone Number
Your answer
Youth Phone Number
Your answer
Parent Email Address
Your answer
Youth Email Address
Your answer
Family Primary Language
Your answer
Medical Conditions- Check all that apply
Allergies- Check all that Apply
Do you receive Free or Reduced Lunch
Have you played Baseball/Softball Before
If yes, Where? What position?
Your answer
What other After School Programs are you involved with?
Your answer
What days are you available for Programming?
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