2009/2010 Senior Rep application

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Contact Info

Full Name: *

First *

Middle

Last *

Parent's Phone #: *

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Cell Phone #: *

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Address

Street Address *

Address continued

City *

State *

Zip *

Email *

Facebook Page *

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All about you!!!

Age *

Birthdate *

High School *

Graduation date *

What extra curricular and/or community activities are you involved in? *

Any hobbies or interests? What do you like to do for fun? *

Do you feel you are a good influence on your peers? Please elaborate. *

Describe your personality. What defines who you are? What's your style? *

Why do you think you would be a good Senior Rep for Emerald Rose Senior Style? *

I shoot mainly on location and like to try new ideas. Are you willing to try non-traditional locations and new ideas? Even if it means getting your formal wear wet or dirty? *

Please note that I am not responsible for damage or cleaning fees to clothing.

Gender * MaleFemale

Parent/ Guardian Info

Full Name: *

* Mrs.Mr.Ms.Miss

First *

Last *

Relationship to Senior * MotherFatherLegal Guardian

If you chose Legal Guardian please specify if you can.

For example: Grandmother, Grandfather...

Email *

Phone #: *

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Digital Signature

Today's Date: *

Full Name: *

First (legal) *

Middle *

Last (full legal surname) *

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