Thank you for applying for the Teen Machine. (Teens and Leaders)

If you are under the age of 18, a parent or guardian must fill out the bottom portion.

First Name: Last Name: Age:
Area of Residence (ex. Rutland, Mission See map):
Phone Number: E-mail:
Work Experience: (Job Title / Employer / Starting-Ending Date)
Volunteer Experience: (Job Title / Employer / Starting-Ending Date)
Time Availability: Anytime Weekday Afternoons Weekday Evenings
Weekends Other
References: (Name / Contact Number / Relation)

Parent / Guardian Information (required if applicant is under the age of 18)

First Name: Last Name:
Day-Time Phone Number: Evening Phone Number:
Are you interested in supervising activities?:
The above information is correct, and I approve of my child participating with the Teen Machine.

Note: We will do a follow up call for verification of parental / guardian information.