Summer Application

Personal Information

NOTE: This photo will appear on your ID

School Information

About You

Health Information

Are you taking any medications?
Medicine Allergies?
Food Allergies?
Are you covered under a health insurance plan?
I understand that basic medical coverage is required to participate in this program. It can be made available at a minimal per week charge. (for more information contact your canvassing leader)

Parent/Guardian Information


Enter the email addresses for two references. They will be sent a form to fill out. Your application will not be processed until we receive responses from both references, so you may want to check that they have received and completed the form. References must be a teacher, pastor, or work supervisor. No relatives.

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