P.O.L.i.S.H. for girls Enrollment Information Sheet

P.O.L.i.S.H. for girls

Enrollment Information Sheet
Annual membership fee $50 *

INITIAL MEMBERSHIP RETURNING MEMBER
FIRST NAME *
MIDDLE NAME *
LAST NAME *
Grade level *
AGE GROUP:12-14 15-17 18-19 *
Address *

Address

Street Address Line 2

City State

Zip
Phone *
Email *
example@example.com
Parent Email (if Applicable)
example@example.com
Do you have Social Media: (Please Share your page info) optional
FB
IG
Twitter
Driver's License *

Yes No
Exp. Date

Month Day Year
Date
Vehicle Type
Make
Model
Color
Shirt Size *
select your shirt size
EMERGENCY CONTACT:
FIRST NAME *
LAST NAME *
Address *

Address

Street Address Line 2

City State

Zip
Relationship
Phone
Name

FIRST NAME LAST NAME
Relationship
Address

Address

Street Address Line 2

City State

Zip
Any Medical Conditions That Staff needs to be aware of? *
Any known Allergies *
Which Hospital would you prefer:
1stchoice *
Family Physician
Office Number
Blood type (if known)
Religious Preference
How did you hear about POLISH? *
What Prompted You to Join? *
Have you ever done any volunteer/Service work?
If so what, where and when *
Have you ever been a part of an organization similar to POLISH? *
(1) What do you think is your greatest strength? *
(1) What is Weakness you know about yourself and wish to work on? *
Your Interest, Skills, Hobbies *
What Color Describes your personality (Any Color) *
One thing you desire to learn or experience with the group *
PARTICIPANT SIGNATURE *

Clear
Date *

Month Day Year
Date
I have read, understood, acknowledge and agree to conditions of membership and I personally acnsent to the application far Membership of the applicant.
PARENT/LEGAL GUARDIAN CONSENT (IN RESPECT TO AN APPLICANT UNDER THE AGE OF 18 YEARS)
LAST NAME
__________________OFFICE USE ONLY Date Application received_______________________

Month Day Year
Date
Amount paid
Receipt No.
Accepted / Rejected by Club Management - Date
Accepted / Rejected by Club Management
Membership Category allocated
Membership Fee

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P.O.L.i.S.H. for girls

EMERGENCY CONTACT:

PARENT/LEGAL GUARDIAN CONSENT (IN RESPECT TO AN APPLICANT UNDER THE AGE OF 18 YEARS)