Personal Information
First Name:_______________________________
Middle Name:_______________________________
Last Name:_______________________________
Nickname:_______________________________
Date of Birth:_______________________________
Gender: Male / Female
T-Shirt Size:_______________________________
Course Preference
Spanish
French
Address
Street Address or PO Box:______________________________________
Apartment/Unit #:____________________________
City:______________________________
State:_____________________________
Postal Code:__________________________
County:_____________________________
Contact Information
Home Phone:______________________________
Cell Phone:_____________________________
Email Address:_____________________________
School Information:___________________________
High School:________________________________
Principal's Name:______________________________
School Phone:_________________________________
GPA:___________________________________
Family Contact Information
Name(s) of Parents: _______________________________
Father's Home Phone: ______________________________
Father's Work Phone: _______________________________
Father's Cell Phone: _______________________________
Mother's Home Phone: _______________________________
Mother's Work Phone: _______________________________
Mother's Cell Phone: _______________________________
