Youth and Jr. Ambassador Applicaton

Please use participants (youths) information when filling out this form. A parent will be asked to submit with permission at the end of the form.

NAME AND ADDRESS

Please fill out completely

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Date of birth:

EMERGENCY CONTACTS

Please give two Emergency Contacts- The 1st one should be the parent/guardian of the youth giving permission for them to participate as a Volunteer for New Star. Click the Agree button at the end of this application on behalf of your minor.

First name:

Last name:

Home phone:

OK to call here

Cell phone:

OK to call here

Relationship:

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Verified:

CONTACT PERMISSION

Please help us know the best way to contact you.

What is the best way to reach you. (Text, email, phone)

EXPERIENCE AND INTEREST

Please indicate areas of experience and/or interest

AVAILABILITY

Please indicate the days and times you are usually available to volunteer.

Any special notes about availability.

SCHOOL

This area must be filled out by current students

High school:

If volunteering is part of school requirement please list what you will need from New Star (hours, recommendations, etc.)

DEMOGRAPHICS

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Parent/guardian permission

I give my son/daughter (Minor) permission to participate as a New Star Volunteer. I have included my name as the 1st Emergency Contact.

I Agree

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