2024-2025 Debs and Gents Application Form

2024-2025 Debs and Gents Application Form

This application is for students applying to the following programs: Young Debs/Gents and Junior Debs/Gents. Once your application and deposit are submitted, you will receive a welcome letter and a schedule with orientation information. We look forward to being part of your village.
Student Information
Name*

First NameLast Name
Grade*
School (currently attending or will be attending in the 2024-2025 school year)*
Gender*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Student has an IEP?*

YesNo
Hobbies & Interests*

ReadingDrawingDancingSingingActing/TheatreSportsPlaying an instrumentDrawing/PaintingOther
What are two goals you (the student) want to accomplish in the 2024-2025 school year?*
What are your career aspirations? We know this may change over time, but if you had to decide today, what would do you want to do for a living?*
Please upload a headshot.

Cancelof
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first*
Preferred Contact for updates and reminders*

Cell phone textEmailPostal MailOther
Emergency Information

Please list two emergency contacts.
Name #1 *

First NameLast Name
Relationship*
Phone Number*
Name #2

First NameLast Name
Relationship
Phone Number
Health Information

This information is confidential and used to avoid allergens and to ensure students have accommodations if needed.
Please let us know if this child has any allergies*
List medications if this child is currently taking*
Has the student had any serious illnesses or operations?

YesNo
If yes, please describe
Can this child take part in regular physical activities?*

YesNo
Do you want to indicate any related information?
How did you hear about us?*

A friend/colleagueAt SchoolAttending Young Debs Inc EventSocial Media (FB, IG, Twitter)FlyerOther
By signing this application, we, the parent/guardian and the student, agree to fully participate in the program we are applying for. This includes attending and actively participating in community service projects, social events, fundraising events, and etiquette classes.

We, the parent/guardian and the student, agree to follow the rules and regulations established by Young Debs Inc. We understand that failure to abide by these standards may result in forfeiture of participation in the program and all associated privileges.

As the parent/guardian, I agree to uphold the rules and regulations established by Young Debs Inc. and to assist in ensuring my child abides by these standards. I acknowledge that the organization reserves the right to add amendments to the handbook as needed and that I will be notified of any such changes.

I confirm that all information provided in the application is accurate. I understand that providing false information may result in my child's dismissal from the program. I agree to submit all dues by the specified deadline and understand that payments can be made in installments until the final deadline. I acknowledge that the program dues are $450 for the year, regardless of my child's participation in all events. A $50 non-refundable payment must accompany this application to hold my child's place in the organization. This amount will be deducted from the annual dues of $450.

I have read, understood, and accept the rules for participation in Young Debs Inc.
Young Debs Inc has my permission to use photographs, videograpghy or audio of me or my child (a minor under 18 years of age) taken during Young Debs Inc activities for use on their website or other promotional material. These audio-vidual tools may be posted on social media platforms as well as used for marketing and promotions within the Young Debs Inc (eg website, newletters, ads, IG, Facebook).
Date of Registration*

MonthDayYear
Date
Signature

Powered by Jotform SignClear
My Products
prevnext( X )
$50 Application Fee & DepositThis is a non-refundable application fee and deposit. This will be deducted from the yearly $450 dues.
$50.00 Quantity

Total

$0.00
loading smart payment buttons...

The payment is ready! It will be completed once you submit the form.
Should be Empty:

2024-2025 Debs and Gents Application Form

Student Information

Parent(s)/Guardian(s) Information

Emergency Information

Health Information