_{hsm youth connect form}

first name.

last name.

gender

birthdate.

what grade are you?

freshman

sophmore

junior

senior

email.

phone number.

instagram username (@)

address

apartment, suite, etc.

city

state

postal / zip code

what is the name of your highschool

what are you in to?

do you have a job?

yes.

no.

who do you work for?

parent contact info:

parent/guardian first name

parent/guardian last name

parent/guardian phone number

parent/guardian email

anything to add?