Club Membership Registration Form

Membership Application

Complete the form below to sign up for our membership service.
Name*

First NameLast Name
Age*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*

Area CodePhone Number
Do you live with Mother, Father or Both or Other*

MotherFatherBoth ParentsOther
Please provide the name of your guardian*

First NameLast Name
Please provide the contact information for your guardian:*

Area CodePhone Number
School Name*
School Address*
School Phone Number*

Area CodePhone Number
Guidance Counselor*
School Grade*

High School Freshmen (Grade 9)High School Sophomore (Grade 10)High School Junior (Grade 11)High School Senior (Grade 12)
Current GPA*
Please list the current courses your enrolled in:*
Do you have a job? If yes - company name, address and manager: *
Business Name & Manager Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please write a 200 word essay on why you want to be a part of Jackie's Angels*

Upload a File

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Membership Rules
Confirmation

I have read, understood, and accepted the rules for membership.
MEMBERSHIP RULES

1. Age range is 12 – 18 years old

2. Must live in the Los Angeles and Surrounding areas

3. At least a C average
Once you submit your application, we will contact you shortly to complete your membership.

Thank you!
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Membership Application