Team Voltage Student Application Form
First Name *
Your legal name, not a nickname
Last Name *
Student Email Address *
Parent Email Address
The parent/guardian who is your primary contact
Parent Name (Last, First) *
The parent/guardian who is your primary contact
Street Address *
City *
State *
Zip *
Parent Phone *
The preferred phone number for reaching parent if needed.
Student Cell Phone
Required if student has a cell phone.
Student Date Of Birth *
MM
/
DD
/
YYYY
School Student Attends *
What Grade are you in? *
Student T-Shirt Size *
Additional Parent/Guardian name
Include relationship if not obvious
Medical
Medications *
Choose None or List medications or medical condition next to Other
Allergies *
Choose None or List Allergies next to Other
Emergency Contact Information
Additional Emergency Contact
If you you have another emergency contact other than the parent/guardian indicated above, please indicate name and relationship below i.e. John Smith (father)
Phone number of the Emergency Contact
You can list more than one phone number if needed.
Additional Information
If there is additional information that Mr. Gabeler should be aware of, please indicate below
Have you previously been a member of Team Voltage?
Clear selection
Describe Yourself!
Describe Yourself in 50 words or less including at least one strength and one weakness.
Submit
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