Applicant:      Last: First: mi     age:          Phone:  (  )-

  DOB: year:   month: day of month:   is applicant  m=male or f=female

 address: (number)   street name:  apt#

city of residence:    state: zip:

school : grade: GPA: church if any:

Parent / Guardian info:

 Last: First:  m.i.    relationship to applicant: A=Aunt F=Father M=mother O=Other   address if not the same:  parent phone:( )

                                cell phone:)  / work:)

                          why do you want to be part of YLC (please let your child fill this out): (7-17 yrs old)