View fullsize Photo Release Form Medical Release Form Youth Automotive Careers Exploratory Academy July 14, 2025 - July 18, 2025 Name * First Name Last Name Birthdate * MM DD YYYY Age * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone (###) ### #### Name of Parent/Guardian * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Emergency Contact First Name Last Name Emergency Contact Number (###) ### #### Current School * School Address Address 1 Address 2 City State/Province Zip/Postal Code Country Current Grade * Shirt Size * Small Medium Large X-Large 2X-Large 3X-Large Gender * Male Female Ethnic Background Native American Indian/Alaskan Black (other than Hispanic) White (Other than Hispanic) Asian/Pacific Islander Hispanic Other List the school activities, clubs, organizations or sports teams in which you participated during this school year. What is your interest in attending the Youth Careers Exploratory program that will explore careers in the automotive industry? How do you think it will add to your interest? Please write a paragraph in the space below. How did you hear about the program? The following questions does not determine eligibility for the program but may qualify the student for certain resources. Do you the parent/guardian receive Medicaid, EBT or SSI? Yes No Does the student receive free lunch? Yes No Do you the parent have a full or part time job? Yes No Did you attend this Academy last year? Yes No The following documents should be submitted with your application and interest essay. Thank you!
