Precious Pearls Youth Group Application

Precious Pearls Youth Group Application
* You are required to upload the transcript, media, and affirmation files if completing the application online or a hard copy application packet may be submitted at the Open House meeting in August.

No incomplete form will be accepted.
Student Information
Name: *

Last Name First Name
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number:

Area Code Phone Number
Cell Phone Number:

Area Code Phone Number
E-mail: *
Age: *
Date of Birth (mm/dd/yy) *
Grade Level: *
Current GPA: *
T-Shirt Size
Small, Medium, Large, XLarge, 2XLarge, 3XLarge
School Name: *
Community Service Hours:
Do you have an after-school job?

Yes No
If yes, where do you work?
How many hours per week?
List all extracurricular activities in which you participate:
Please list all Social/Community Groups in which you participate:
Parent/Legal Guardian Information
Parent/Guardian Name: *

Last Name First Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number:

Area Code Phone Number
Cell Phone Number: *

Area Code Phone Number
E-mail: *
Emergency Contact Information
In case of emergency contact: *

Last Name First Name
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Relationship to Student: *
Do you have any allergies or health concerns that we should be aware of?
* The Media Release and Affirmation files can be found on akagto.com.
Upload Transcript: *
Upload Signed Media Release File: *
Upload Signed Affirmation File: *
Should be Empty: