Minnesota youth rush application

Name

Preferred Nickname

How old will you be on June 4th 2017?

Phone

Home Address

Marital Status

Single Married

Gender

Male Female

How did you hear about Minnesota Youth Rush?

What type of music do you enjoy listening to?

Can you provide documentation that you are authorized to work in the U.S.?

Yes No

Have you ever been convicted of a felony?

Yes No

School Name (optional)

Grade/ Major

What school will you attend next year?

School Address

(Reference) Pastors Name

Pastors Phone

Years Known

(Reference) Non-relative Name

Non-Relative Phone

Years known

(Minors Only!) Fathers Name

Mothers Name

Parents Phone

Parents Address

Questions/ Comments