NCIS: Wausau Counselor Application
THANK YOU for your interest in being a Counselor for NCIS: Wausau. Please fill out the form below in order to let us know about you and your interest in helping with NCIS: Wausau! We will be in contact with you shortly to discuss this opportunity with you further.
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Youth's Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
T-Shirt Size *
Adult Sizes
Youth Home/Primary Phone Number *
For some this is a landline at home, for others it is Mom or Dad's cell phone, regardless, please specify a "Primary Phone" for your family
Your answer
Youth Cell Number
If you have one to share
Your answer
Do you accept texts?
Home/Primary Email Address *
For some it is mom or dad's email. For others, it is your own email address as a teen. Let us know the best way to reach you via email.
Your answer
Youth Email Address
If you have one to share
Your answer
Mother's Name *
Your answer
Mother's Cell Number
If you have one to share
Your answer
Mother's Email Address
If you have one to share
Your answer
Father's Name *
Your answer
Father's Cell Number
If you have one to share
Your answer
Father's Email Address
If you have one to share
Your answer
School *
Grade *
For the upcoming 2017-2018 Academic Year
Parish/Church of Membership *
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