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?