MISS KANKAKEE SCHOLARSHIP ASSOCIATION LITTLE MISS & MR. KANKAKEE
APPLICATION
Parent Information
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First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
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Participant's Information
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First Name
Last Name
Participant's Age
*
Date of Birth
*
Participant's Gender
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Male
Female
Name of School
What do you want to be when you grow up?
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What is your favorite hobby or thing to do?
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Ex: gardening, riding your bike, traveling
What is your favorite food?
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Ex: fries, vegetables, cupcakes
What is your favorite color?
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Ex: red, blue, green
What is your favorite subject in school?
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If not in school leave blank or type N/A
What is the name of your pet (s) and what type of pet is it?
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Ex: Dog - Waldo
Please list any allergies (food, medications, etc.).
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Also list any medical conditions we should be aware of?
Please upload a clear high-quality headshot- must be in jpeg format
*
Submit
Should be Empty: