BOSS Program Application

Thank you for your interest in joining BOSS. Please put N/A in any fields that are not applicable. Once completed, you will be contacted by a BOSS team member.

Student's First Name *

Student's Last Name *

Nickname

Birth Date *

// (mm/dd/yyyy)

Mobile Phone *

Phone 2 *

Phone 2 Type *

Student's Email

Street *

City *

State/Province *

Zip *

School Name *

Grade Level *

If you play sports for school, church, or travel clubs, please let us know which sports you play. *

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

Yes
No

Please explain. *

Do you have an education plan at your school? *

Yes
No

If applicable, list the type of education plan (IEP, IAP, 504 Plan, Other) *

If other, please list *

How did you hear about us? *

Parent/Guardian Full Name *

#1 Parent/Guardian Email *

Emergency Contact Full Name *

Emergency Contact Phone Number: *

Emergency Contact Relationship: *

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 par

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BOSS Program Application