Name: Last:
MI:
First:
Date of Birth: (MM/DD/YYYY):
Mailing Address: Street:
City: State: Zip:
Phone: (Area Code) (Phone Number) Home:
Cell: E-Mail:
T-Shirt Size:
Child: Sm, Med, Lg, XL,
Adult: Sm, Med
PARENT INFORMATION
Mother's Name: Phone Number: Email Address:
Father's Name: Phone Number: Email Address:
SCHOOL INFORMATION
Name of School: Grade:
List School Organization(s) you are involved in: (Academic, Social, Sports)
List Church and Ministries or Activities you participate in (if applicable):
Name of Church:
Ministries/Activities:
In a few words, tell us why you would like to participate with and become a Sunrise Ruby:
In a few words, tell us something you would like for us to know about you:
Parental Consent:
I Parent of
consent to allow my daughter to participate in the Sunrise Rubies program.
I understand that this is a four-month program and that my child will be required to attend each session from the time it begins each session to the end of the session to fully complete the program.
Mother/Guardian’s Signature:
Phone
Father/Guardian’s Signature:
Phone:
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