Student Information Form
Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Club Site
*
Please Select
Hanover Area High
EHMMS/Hanover Middle
New Oxford
Girl Talk Hanover
Girl Talk Manchester Valley
Girl Talk Westminster
Bermudian Springs Middle
Manchester Valley High
North Carroll Middle
Northwest Middle
Shiloh Middle
Westminster Area High
Westminster Area Middle
What school do you attend?
Grade
Parent/Guardian Name
*
Parent/Guardian Cell Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email
example@example.com
What other activities are you involved in (for example: band, sports, choir, 4H, etc.)?
Which social media platforms do you use?
Facebook
Instagram
Snapchat
X
Other
Submit
Should be Empty: