1.Volunteer Contact Information

First Name

Last Name

Home Address

City/Town

Zip Code

Home Phone Number

Your Cell Phone Number

Email Address

*2.Age(Required.)

12

13

14

15

16

17

18

Other (please specify)

3.Date of Birth (Please enter in MM/DD/YY format)

*4.Your School(Required.)

Kenmore East

Kenmore West

St. Joe's

Franklin Middle

Hoover Middle

St. Amelia's

Cardinal O'Hara

Mount Saint Mary

Sweet Home High School

Sweet Home Middle School

St. John the Baptist

St. Andrew's

Other (please specify)

*5.Grade(Required.)

6

7

8

9

10

11

12

Other (please specify)

*6.T-Shirt Size(Required.)

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Other (please specify)

*7.How many service hours are you required to complete each year?(Required.)

None

1-15

16-20

21-35

36-50

51-75

76-100

100 or more

*8.How did you hear about YES?(Required.)

Friend/member

Teacher/counselor

Youth, Parks & Recreation website or flyer

Saw YES at an event

Other (please specify)

9.Parent/Guardian 1 Information

Name

Phone Number

Alternate Phone Number

Email Address

10.Parent/Guardian 2 Information

Name

Phone Number

Alternate Phone Number

Email Address

11.Emergency Contact 1 (different from above)

Name

Relation

Phone Number

Alternate Phone Number

12.Emergency Contact 2 (different from above)

Name

Relation

Phone Number

Alternate Phone Number

13.Preferred Hospital

14.Name of Physician

*15.Do you have any allergies, physical restrictions, or health or behavioral issues we should be aware of?(Required.)

Yes

No

16.If you answered yes to question 9, please describe