Exit Youth Engaged in Service Volunteer Application Question Title * 1. Volunteer Contact Information First Name Last Name Home Address City/Town Zip Code Home Phone Number Your Cell Phone Number Email Address Question Title * 2. Age 12 13 14 15 16 17 18 Other (please specify) Question Title * 3. Date of Birth (Please enter in MM/DD/YY format) Question Title * 4. Your School 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) Question Title * 5. Grade 6 7 8 9 10 11 12 Other (please specify) Question Title * 6. T-Shirt Size Adult Small Adult Medium Adult Large Adult XL Adult XXL Other (please specify) Question Title * 7. How many service hours are you required to complete each year? None 1-15 16-20 21-35 36-50 51-75 76-100 100 or more Question Title * 8. How did you hear about YES? Friend/member Teacher/counselor Youth, Parks & Recreation website or flyer Saw YES at an event Other (please specify) Question Title * 9. Parent/Guardian 1 Information Name Phone Number Alternate Phone Number Email Address Question Title * 10. Parent/Guardian 2 Information Name Phone Number Alternate Phone Number Email Address Question Title * 11. Emergency Contact 1 (different from above) Name Relation Phone Number Alternate Phone Number Question Title * 12. Emergency Contact 2 (different from above) Name Relation Phone Number Alternate Phone Number Question Title * 13. Preferred Hospital Question Title * 14. Name of Physician Question Title * 15. Do you have any allergies, physical restrictions, or health or behavioral issues we should be aware of? Yes No Question Title * 16. If you answered yes to question 9, please describe Next