School Name:
Address:
City:
State:
Zip:
Office Phone:
Fax:
School Principal:
Junior Sponsor/Advisor:
Jr. Sponsor Email:
Jr. Sponsor Address:
City:
State:
Zip:
Jr. Sponsor Home Phone*:
Cell Phone*:
(* for emergency use only)
Junior Class President:
Jr. Class President Email:
Number Attending
(Max. of 6 - Junior Class Sponsor,
Junior Class President and 4 other Juniors/Chaperones):
We would like to spend the night:
Yes
No
Number of Rooms:
Overnight Date (MM/DD/YY):
Have you ever worked with us before?
Yes
No
If so, who was your coordinator?