2024-25 RETURNING STUDENT RISING STARS BUSINESS ACADEMY ENROLLMENT APPLICATION

2023-2024 Intake Application Form
Shirt Size:*
Age:*
Date*

MonthDayYear
Date
Participant Information
Name*

First NameMiddle NameLast Name
Physical Address*

Street Address

Apartment

CityState / Province

Postal / Zip Code
Is this permanent housing?*

YesNo
If no, please briefly describe what type of temporary housing your physical address represents:
Email*
example@example.com
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Birthdate*

MonthDayYear
Date
Birth City:*
Birth State:*
Birth Country*
Gender*

MaleFemale

Additional Participant Information
Are you physically capable to participate in all physical activities?*

YesNo
If no, explain:
Are you currently on any medication?*

YesNo
If yes, please specify:
Do you currently or have you ever had any special health conditions (for example: asthma, seizures, hearing impaired, etc.?)*

YesNo
If yes, please explain:

RISING STARS BUSINESS ACADEMY RETURNING STUDENT ENROLLMENT APPLICATION