2022 West Palm Beach Alumni Kappa League Membership Application Form

Parent Information
Mother's Name *

First Name Last Name
E-mail
Phone Number *

Area Code Phone Number
If Differnt than child

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Notes or Comments
Father's Name *

First Name Last Name
E-mail
Phone Number *

Area Code Phone Number
If Differnt than child

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Notes or Comments
Guardian's Name (if applicable)

First Name Last Name
E-mail
Phone Number

Area Code Phone Number
If Differnt than child

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Notes or Comments
Household Information
Youth lives with: *
Number of people in your household? *
How many brothers *
How many sisters *
Emergency Contact
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Alternative Number

Area Code Phone Number
PLEASE NOTE!!!

Members of Kappa League are expected to
maintain a decorum and attitude that is aligned with the objectives of the
program.

Kappa League is an entity sponsored by
Kappa Alpha Psi Fraternity Inc. however its participants are not considered or
affiliated as members of the fraternity!!

School Information
School Attending *
Grade *
Current GPA *
List all Honors and Outstanding Achievements you have received.
What is your favorite subject
What is your hardest subject
What Colleges or Universities would you like to attend?
College A *
College B *
College C
Youth Signature *
Date
Parent Signature *
Date
PLEASE NOTE!!!

Members of Kappa League are expected to
maintain a decorum and attitude that is aligned with the objectives of the
program.

Kappa League is an entity sponsored by
Kappa Alpha Psi Fraternity Inc. however its participants are not considered or
affiliated as members of the fraternity!!

Photo Release
I give permission to the West Palm Beach Alumni Chapter of Kappa Alpha Psi Fraternity, Inc. to use any photograph taken of my child for its website, marketing material, and event signage, to promote the Fraternity and its Guide Right Program.
Parent/Guardian Signature
Date

Month Day Year
PERMISSION SLIP FOR OUTINGS AND RELEASE OF LIABILITY
I hereby give my permission for my child to participate in all West Palm Beach Alumni Guide Right sponsored activities.

As the natural and legal guardian of the above named child, I hereby certify to the best of my knowledge the said person is free from contagious disease, and is fit to participate in all I WPBA Guide Right activities. I hereby hold West Palm Beach Alumni Guide Right, West Palm Beach Alumni Guide Right volunteers, West Palm Beach Alumni Guide Right staff and participating organization FREE OF ALL LIABILITIY resulting from participation in the activities organized by WPBA Guide Right. I understand that this permission may be revoked at any time in writing signed by me and received at the office of West Palm Beach Alumni Guide Right, and that unless revoked this permission and release will be relied upon by the WPBA Guide Right staff, volunteers, and participation organizations.
Parent/Guardian Signature
Date

Month Day Year
Application Fee *
prev next ( X )
Kappa League Application Fee $ 66.50

Total $ 0.00
PLEASE NOTE!!!

Members of Kappa League are expected to
maintain a decorum and attitude that is aligned with the objectives of the
program.

Kappa League is an entity sponsored by
Kappa Alpha Psi Fraternity Inc. however its participants are not considered or
affiliated as members of the fraternity!!
Should be Empty:

West Palm Beach Alumni Kappa League Membership Application

Youth's Information

Parent Information

Household Information

Emergency Contact

School Information

Photo Release

PERMISSION SLIP FOR OUTINGS AND RELEASE OF LIABILITY