CHAMPS STUDENT APPLICATION
12-18 YEARS OLD
SCHOOL NAME *
Your answer
LAST NAME *
Your answer
FIRST NAME *
Your answer
ADVISOR
Your answer
STUDENT ID# *
Your answer
STREET ADDRESS
Your answer
EMAIL ADDRESS *
Your answer
CELL PHONE NUMBER *
Your answer
ARE YOU A GARY COMER YOUTH CENTER MEMBER *
GRADE *
Your answer
PHONE NUMBER
Your answer
BIRTHDATE
MM
/
DD
/
YYYY
PARENT/GUARDIAN'S NAME
Your answer
PARENT/GUARDIAN'S CELL NUMBER *
Your answer
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