Youth City Council Application

Youth City Council Application Part 1

Date

Name

First Last

Phone Number

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Email Address

Birth Date

Age

Grade

Parent/Guardian Name

First Last

Parent/Guardian Phone Number

Parent/Guardian Address

Street Address City State / Province / Region ZIP / Postal Code Country

Emergency Contact Information

Name

First Last

Phone Number

Relationship to you

Youth City Council Application Part 2

Do you have a job?

Do you participate in extra circular activities such as sport programs?

Harrisville Youth City Council positions I am interested in holding (Click all that apply)

Please describe why you would like to serve on the Harrisville Youth City Council.

If you wish to refer a friend to the Harrisville Youth City Council, please list their name and phone number:

Youth City Council Application Part 3

Current School Attending

What other school activities and clubs are you active in?

List community activities that you have been involved in

Harrisville City, Utah