Enrollment

Date*

Age*

(Youth) First Name*

(Youth) Last Name*

(Youth) Phone Number*

(Youth) Email Address*

(Parent) First Name*

(Parent) Last Name*

(Parent) Phone Number*

(Parent) Email Address*

Address*

City

State

Postal/ Zip Code

School*

Grade Level*

How did you hear about us?

Does the child have any medical conditions that we should be aware of?*

Reasons for joining?*

Join Us Today

Together, we can empower the next generation to unleash greatness!

Become part of the Gloves Against Drugs family and help us create a positive and lasting impact on the lives of young people in our community.