Jóvenes en Acción Application Art Discipline SelectionIf you were to rank your preferred art discipline, which would be your first choice?* DANCE MUSIC THEATRE If you were to rank your preferred art discipline, which would be your second choice?* DANCE MUSIC THEATRE If you were to rank your preferred art discipline, which would be your third choice?* DANCE MUSIC THEATRE How did you find out about our Jóvenes en Acción (JEA) program?* Music Clubhouse (MCH) Dance and/or Theatre at Hennigan or Margarita Muniz Academy Social Media School Presentation Flyer School Field Trip to HSTF Teacher Friend Opportunity Fair Viva Event Other Other:Participant InformationName:* First Last Date of Birth:* MM DD YYYY Age*Gender:* Male Female Other If other, please specify:*Address:* Street Address City State / Province / Region ZIP / Postal Code Home Phone Number:*Cell Phone Number:*Email Address:* Race (check all that apply):* Black White Latino Asian Other If other, please specify:*Ethnicity:*Country of Birth:*What school do you currently attend?*What grade are you in?*Parent / Guardian InformationParent / Guardian Name:* First Last Relationship to Youth:*Address:* Street Address City State / Province / Region ZIP / Postal Code Home Phone Number:*Cell Phone Number:*Email Address:* Parent / Guardian Country of Birth:*Consent You have my consent.The information provided on this form is true and accurate to the best of my knowledge and I give permission for my son/daughter to participate in Hyde Square Task Force programs and activities.Parent / Guardian Signature:*Participant Signature:*Date:* Date Format: MM slash DD slash YYYY
