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Fayola Man Summer Leadership Academy
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1.
Student Contact Information
(Required.)
Name
School
Student ID Number
Address
City/Town
ZIP/Postal Code
Birthdate
Email Address (If applicable)
Phone Number
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2.
Allergies
(Required.)
*
3.
What's your T-shirt Size?
(Required.)
Youth Small
Youth Medium
Youth Large
Regular Small
Regular Medium
Regular Large
XL
Other (please specify)
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4.
Do you have any summer travel plans that will happen during the summer academy? If yes, what are those dates? (YOU MUST BE PRESENT FOR 80% OF THE SUMMER ACADEMY)
(Required.)
*
5.
Who would be your emergency contact and their phone number?
(Required.)
*
6.
Parent/Guardian Contact Information
(Required.)
Name
Address
City/Town
Email Address
Phone Number
7.
Does your young man need transportation to and from our summer academy?
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8.
Do you agree to allow us to use your photo in our marketing material (social media and print)?
(Required.)
Yes
No
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9.
What grade will you be in next school year? (6th, 7th, & 8th grade seats are full)
(Required.)
4th
3rd
5th
6th(Full)
7th(Full)
8th(Full)
