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Youth Court Member Information
Name: __________________________________ Date: ____/____/____ Current Age _____________ DOB: ____/____/_____ Address:__________________________________________________________________________________________________________________________ ZIP _________________ Home Phone: __________________ Cell Phone: ____________________ Email Address : _______________________________________________________________ School Attending: _____________________________________________ Grade Level: _____________ Year You Started with Youth Court : ______________________________
List any extra curricular activities: __________________________________________________________________________________________________________________________ Clubs or community service activities: __________________________________________________________________________________________________________________________ Are you employed? NO YES Where? ______________________ Hrs _________________________________________________________ Times available: _______________________________________________ Do you have transportation ? YES NO List any friends also interested Youth Court : ______________________________________________________________________________ Why do you want to be a Youth Court Member? ____________________________________________________________________________________________________________________________________________________________ What can you offer the Youth Court Program: ____________________________________________________________________________________________________________________________________________________________ List 3 Character references, phone numbers, & relationship (no relatives). ______________________________ ______________________ _______________________ ______________________________ ______________________ _______________________ ______________________________ ______________________ _______________________ Person to Contact in case of an emergency: Name: ______________________________________________ Relationship: _________________________________________ Phone Number: _______________________________________ Work Number: ________________________________________ Cell Number: _________________________________________ Address:______________________________________________________________________
____________________________________________________ ____/____/____ Youth’s Signature Date
I the Parent/Guardian wish to receive the general Youth Court information which would include things like times and dates of activities and the newsletter (this would not include actual Court Hearing information).
NO YES if yes please place information below on how to notify.
____________________________________________________ ____/____/____ Parent’s Signature Date
Email: _____________________________________________________________
Mailing Address: _____________________________________________________________________________ _____________________________________________________________________________
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