EmailMe Form - NRCW Student Application

Student Name *

First Last

Gender *

Date of Birth *

MM / DD / YYYY

Race/Ethnicity

Age

Student Email *

High School

Grade *

Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Phone

### - ### - ####

County of Residence *

Sponsoring County (if different)

I certify that I will be entering the 10th, 11th, or 12th grade at the beginning of the 2017-2018 school year. I have never attended a Natural Resources Conservation Workshop. I understand this is a workshop, and I will participate in all activities; show respect for property and facilities used; assume financial responsibility for any damage caused by me. I understand failure to follow the rules of conduct will result in my being sent home immediately. I UNDERSTAND THAT THE RULES OF CONDUCT PROHIBIT ANY USE OF TOBACCO PRODUCTS, ALCOHOL, OR DRUGS NOT PRESCRIBED BY DOCTOR AND THIS WILL BE STRICTLY ENFORCED. *

Student Signature *

Clear

Shirt Size (Adult Sizes)

Parent/Legal Guardian Name *

First Last

Parent/Legal Guardian Email *

Mailing Address is Same as Student Address *

Yes

No - please enter address below.

Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone

### - ### - ####

Mobile Phone

### - ### - ####

Work Phone

### - ### - ####