Fayola Man Summer Leadership Academy

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* 1. Student Contact Information

Name

School

Student ID Number

Address

City/Town

ZIP/Postal Code

Birthdate

Email Address (If applicable)

Phone Number

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* 2. Allergies

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* 3. What's your T-shirt Size?

Youth Small

Youth Medium

Youth Large

Regular Small

Regular Medium

Regular Large

XL

Other (please specify)

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* 4. Do you have any summer travel plans that will happen during the summer academy? If yes, what are those dates? (YOU MUST BE PRESENT FOR 80% OF THE SUMMER ACADEMY)

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* 5. Who would be your emergency contact and their phone number?

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* 6. Parent/Guardian Contact Information

Name

Address

City/Town

Email Address

Phone Number

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* 7. Does your young man need transportation to and from our summer academy?

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* 8. Do you agree to allow us to use your photo in our marketing material (social media and print)?

Yes

No

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* 9. What grade will you be in next school year? (6th, 7th, & 8th grade seats are full)

4th

3rd

5th

6th(Full)

7th(Full)

8th(Full)