2024-2025 7th Grade Initiative Program Application
Please note: This application is to be completed by both the student and a parent/guardian.
Student Name:
*
First Name
Last Name
Student DOB:
*
/
Month
/
Day
Year
Date
Student Gender:
*
WWFY Member Status
*
Please Select
Non-member
Family 1
Family 2
Teen
Youth
Parent/Guardian Name:
*
First Name
Last Name
Parent/Guardian DOB:
*
/
Month
/
Day
Year
Date
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number:
*
Parent/Guardian Email:
*
example@example.com
The student is attending:
*
Bedford Middle School
Coleytown Middle School
Weston Middle School
Other
School verification document
*
Report Card
School ID
Other
Please attach image/scan of school verification document
*
Browse Files
Cancel
of
Student Health History
Has your child ever had a heart condition and/or been advised to only perform physical activity recommended by a doctor?
*
no
yes
Does your child have any history of epilepsy or seizures?
*
no
yes
Is your doctor currently prescribing any medication for your child?
*
no
yes
Does your child have allergies that require them to carry an EpiPen?
*
no
yes
Is there any other reason why your child should not engage in physical activity?
*
no
yes
If you answered yes to any of the above health questions, please provide details below:
Is there anything unique about your child that we should be aware of while they are in our care?
Parent Agreement
*
Student Agreement
*
Parent/Guardian Signature:
*
Student Signature:
*
Date:
*
/
Month
/
Day
Year
Date
Submit
Should be Empty: