TAYLOR MADE PREP ACADEMY
APPLICATION
Name
*
First Name
Last Name
Gender
Height
Date of Birth
*
-
Month
-
Day
Year
Mailing Address
*
Address Line 2
City
State / Province
Postal / Zip Code
Country
Phone Number
*
-
Area Code
Phone Number
Email
*
Insurance Provider
*
Group Number
*
Member ID
*
School Name (Last School)
*
School Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
School Phone Number
-
Area Code
Phone Number
Current Grade
*
Grade Point Average
*
Graduation Year
*
Shirt Style
*
Youth
Men's
Women's
Shirt Size
*
Small
Medium
Large
X Large
XX Large
Complete "Parent" section if student is under 18
Parent's Name
First Name
Last Name
Parent's Phone Number
-
Area Code
Phone Number
Parent's Email
Parent Signature
Please verify that you are human
*
Submit
Should be Empty: