BOSS Application

To apply to BOSS, please complete and submit the application below. Thank you and good luck!

Personal Information

Name

First Name

Last Name

Name you prefer / nickname

Home phone

Mobile phone

E-mail address

Street Address

State

ZIP Code

School

Grade

Date of birth

Please indicate which camp you would like to attend:

Long Beach Camp

Do you play sports for school, church, or travel clubs?

Yes No

Are you willing to make your academic and personal success as much of a priority as your athletic success?

Yes No

How did you hear about our program?

Person to contact in case of emergency

First

Last

Relationship

Phone number

References

Please provide a letter of reference from a school administrator, teacher, coach or counselor who can attest to your character and commitment to developing “whole”, positioned and prepared to live a life of purpose.

Participation Agreement

By submitting this application, I affirm that the facts set forth in my application for participating are true and complete. Thank you for completing this application form and for your interest in participating in our Boss program. All the information recorded above is considered confidential.

Parent name/consent (if under 18):

First

Last

Date

Mehedi Hasan

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