MEMBERSHIP APPLICATION ST. GEORGE YOUTH CENTER, Isla Vista Parent/Guardian Information First name
Last name
DOB
Relationship to Member
First name
Last name
DOB
Relationship to Member
Address
City
Home Phone
Cell Phone
State
Work Phone
Zip code
Can you receive text msg?
Email Prefered Language Spoken At Home (for grants)
Highest School Completion By Parents/Guardian (for g rants)
Do You Qualify For Free/Reduced Lunch At School (for grants) Other contact in case of emergency
Household Size (for grants) Telephone
Relationship to member
Y outh in Family First Name
Last name
Relationship to member
Date of birth
Y outh in Family First Name
Member? Yes No Last name
Relationship to member
Date of birth
Last name
Relationship to member
Date of birth
Member? Yes No Gender Grade
Last name
Relationship to member
Date of birth
Member? Yes Gender
No Grade
Last name
Relationship to member
Date of birth
Member? Yes Gender
No Grade
Last name
Relationship to member
Date of birth
Y outh in Family First Name
Y outh in Family First Name
Y outh in Family First Name
Y outh in Family First Name
Member? Yes No Gender Grade
Gender
Grade
Member? Yes No Gender Grade