Applicant’s name:____________________________Age:___ Date of Birth:___________Grade:______

Address:____________________________________City____________Zip_________________

Phone:_________________Cell Phone:______________Email:___________________________


Mom’s name:____________________Email:__________________________________________

Phone:______________________Cell Phone:_________________________________________

Address (if different from aplicant’s)_________________________________________________


Dad’s Name___________________________Phone:____________Cell Phone_______________

Address (if different from Applicant)____________________________________________________

Emergency Contact:_______________________Phone:______________Cell Phone______________

______I am enclosing my annual fee of $95.00.. This includes uniform shirt, book and craft supplies.

Shirt size (circle one) YS YM YL AS AM AL AXL

If unsure, write down measurements for: Height___________ Chest___________ Waist

__________ Hips___________


Please make your check payable to YWiSE . Mail all your documentation to:


YWiSE Girls Club
1110 Crossroads Dr.
Houston, TX 77079

FOR OFFICE USE ONLY

Payment Received on :___________________ Coments:_____________________________

Amount: _____________________________ _____________________________________

Cash:_______________Check#___________ _____________________________________