B.O.S.S. Student Program Interest Form
B.O.S.S. The Movement is a Christ centered youth success training program where youth ages 6-1/2 to 11-1/2 years old grow in the areas of discipline, risk-taking, personal development, and leadership. B.O.S.S. is an acronym for Building On Spiritual Substance.  To learn more about B.O.S.S. go here.

Please fill out the form below so we can provide you with tailored information that will meet your needs.  

* indicates required field
Sign in to Google to save your progress. Learn more
Today's Date *
MM
/
DD
/
YYYY

B.O.S.S. Class Schedule:

Online Option: 

Phase 1 & 2 classes meet for 1 hour per week for 32 weeks via Zoom OR 2 hours per week for 20 weeks in the Hybrid classes —learn from the comfort of your home.
We have classes forming via Zoom.

Choose the day and time that is best for you and your child.
 *
Required
Student Information
Student's Name *
Sex *
Date of Birth *
MM
/
DD
/
YYYY
Grade Level (i.e., 1st grade, 5th grade, etc.) *
List Additional Children and Ages
Do you know any other parents/guardians that may be interested in their children developing leadership skills at an early age?  List their names, phone numbers, and email below Or indicate that you will forward the Interest form to them.
Has student(s) graduated from a B.O.S.S. program? If yes, please select the appropriate phase:
Parent/Guardian Information
Parent/Guardian Name *
Mobile Phone *
Other Phone
Email Address *
How did you hear about B.O.S.S.? (i.e., Billboard, Radio, Referrer's Name, etc.) *
🌟 May we add you to our VIP list? Get the latest B.O.S.S. updates! 🚀  *
Required
Please note that B.O.S.S. is currently using the Zoom platform for virtual meetings. Please refer to the following websites to review Zoom's privacy policies: https://explore.zoom.us/en/privacy/,  https://explore.zoom.us/en/schools-privacy-statement/
Copyright © 2025 Al and Hattie Hollingsworth's B.O.S.S. The Movement
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms