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BOOM Youth New Member Information Card
Please fill out this information card! Each question with a red asterisk (*) must be answered.
* Indicates required question
Option 1
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Full Name
*
Your answer
Address
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Gender Identity (Male, Female, Other)
*
Choose
Male
Female
Prefer not to say
Other
Race
Your answer
School & Grade (Muskegon Heights, 9th)
*
Your answer
Emergency Contact (Full Name & Phone Number)
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Social Media (Facebook, Snapchat, Instagram
Your answer
Hobbies & Interests
Your answer
Why do you want to join BOOM Youth?
Your answer
Work experience & skills (Jobs, Committees, Programs)
Your answer
Do you work best in
*
Small Groups
Large Groups
One on One
Allergies?
Your answer
Are you currently receiving services?
Yes
No
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Services Received/Receiving (HealthWest, DHHS, JTC)
Your answer
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