Team Voltage Student Application Form
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First Name *
Your legal name, not a nickname
Last Name *
Student Email Address *
Email address of Parent or Guardian *
Email address of your primary contact
Parent/Guardian Name (Last, First) *
The parent/guardian who is your primary contact
Student Street Address *
City *
State *
Zip *
Parent/Guardian Phone *
The preferred phone number for reaching parent/guardian 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
Please provide a secondary 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? *
Describe Yourself!
Describe Yourself in 50 words or less including at least one strength and one weakness.
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