EmailMe Form - O.M.G Club Member Application

Name *

First Last

Date of Birth *

MM / DD / YYYY

Age *

Phone *

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

Race / National Origin

Parent/Guardian Name *

First Last

Parent/Guardian Phone *

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

Email *

Address *

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

Emergency Contact

Name *

First Last

Relationship *

Phone *

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

This application is for enrollment as: (Check On-Campus, ONLY if club is at your school) *

O.M.G Off Campus Club Member

O.M.G On-Campus Club Member

School Information

School Name *

School Grade Level *

Graduation Date

MM / DD / YYYY

Extracurricular, Personal and Volunteer Activities

Talents and Awards:

List each, a description, the level, and number of years of involvement.

Extracurricular Activities:

List your organizations, position, description of the activity, and hours per week of involvement.

Employment:

List the job, your title, description, hours per week, and dates of employment.

Community Service Work:

List the type of work, your role, and hours per week of involvement.

Attach additional Word, Powerpoint, PDF or text document if necessary.

Becoming an Outstanding Mature Girl takes commitment, from both the child and the parent/guardian. As a O.M.G Club member, I agree to follow the rules associated with Outstanding Mature Girlz Organization. I understand that I must respect my club leaders, club members, and myself. I understand, that I must attend all club meetings, community service events, and fundraisers, unless otherwise communicated with club leaders. I agree to conduct myself accordingly in public, and represent myself, and O.M.G. I agree to have fun, and learn the necessary tools needed to succeed in life, and become a productive adult

Do you understand and agree to the terms listed above? *

Yes, I understand and agree to the terms listed above.

O.M.G Club Member Signature *

Clear

Parent/Guardian Signature *

Clear