Jr. High School  Application

Date
Date
Name *
Name
Birthdate
Birthdate
Address
Address
Phone
Phone
If under 18 please answer the following questions about your care provider.
Provider 1
Provider 1
Best phone number to contact?
Best phone number to contact?
Provider 2
Provider 2
Best phone number to contact?
Best phone number to contact?
What areas of service are you interested? *
Active, ambitious, shy, self-confident, persistent, nervous, hard working, impatient, moody, excitable, impulsive, calm, imaginative, serious, easy-going, introverted, good-natured, extroverted, likable, quiet, leader, lonely, submissive, sensitive, prompt, committed, creative, self-asserting, self-conscious, strong-willed
Are you a Christian?
Date 1
Date 1
Date 2
Date 2