Enrollment Application

How To Contact You

Member Name:*

First

Last

Address:*

Street AddressCityState / Province / RegionPostal / Zip Code

Phone:*

Area Code

Phone Number

E-mail:*

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About The Parents

Family Type:*

Housing Status:*

Parent / Guardian:*

Parent / Guardian Name:*

First

Last

Parent / Guardian Cell:*

Area Code

Phone Number

Please add any additional Parent / Guardian information you may have.

Additional Parent / Guardians:

Income Source:

Other Info:*

Food Stamps

Free / Reduced Lunch

Health Insurance

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Who To Contact In Case Of An Emergency

If your child becomes ill or injured while in the care of the South Shore Drill Team, we have the responsibility of notifying the parent or legal guardian.

Emergency Contact 1:*

First

Last

Emergency Phone 1:*

Area Code

Phone Number

Emergency Contact 2:

First

Last

Emergency Phone 2:

Area Code

Phone Number

The above information is correct and complete. I understand that misleading or false information may be cause for enrollment being cancelled.

Agreement to Terms & Conditions:*

Word Verification:

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