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Alpha Beautillion Application Step 1 of 3 33% Name First Last Age*Please enter a number from 15 to 20.Date of Birth* MM slash DD slash YYYY Dietary Needs T-Shirt Size*MediumLargeExtra Large2XL3XL4XL5XLStudent's Cell PhoneStudent's Email* High School* Date* MM slash DD slash YYYY Expected Date of GraduationParent or Guardian's Name* First Last Parent or Guardian's Email* Home Address* Street Address City ZIP Code Home PhoneWork PhoneParent or Guardian's Cell Phone*Emergency Contact* First Last (If different from parent/guardian)Emergency Contact Phone*School Extra-Curricular Activities*Please list all activities in which you have participated. Attach additional sheet(s) if necessary.Recognitions*Please list awards or recognitions received. Attach additional sheet(s) if necessary. How do you feel you can benefit from the Alpha Beautillion Program?*What colleges/universities are you thinking about attending?*What are your career goals?*Can you commit to participate in a minimum of 80% of all activities and 90% of all rehearsals?*Have you ever participated in a BSL Education Foundation Program?* Yes No Date* MM slash DD slash YYYY Please list your community service involvement or leadership activities that you have participated in over the last year?*Please list your community service involvement or leadership activities that you have participated in over the last year?*Please list your community service involvement or leadership activities that you have participated in over the last year?I certify with my signature that all information submitted on 2016-2017 Alpha Beautillion Program Application is truthful and accurate.* Reset signature Signature locked. Reset to sign again I hereby grant permission for the participant to take part in the “BSL Foundation Alpha Beautillion Program,” which is sponsored by the BSL Foundation, Inc. I also agree, on behalf of myself and the participant, not to make any claims or demands of any kind against the BSL Foundation, Inc., employees or agents for any loss or injury that the participant might sustain while engaged in the “Alpha Beautillion Program” including transportation to and from the program site. I authorize such physician or medical staff as the BSL Foundation, Inc. may designate to carry out any minor medical/surgical treatment and/or medication necessary, or to take the participant to the nearest emergency facility, and I/we further authorize its medical staff to provide any treatment deemed necessary for the well-being of participant. I also agree that photographs of the participant may be published for the purpose of publicizing and promoting programs operated and/or sponsored by the BSL Foundation, Inc. I certify with my signature that I understand the fee structure as outlined here. I also recognize that the aforementioned program schedule is tentative and the Alpha Beautillion Committee reserves the right to make changes to the scheduled programmed activities.Name of Parent or Guardian* First Last Date of Parent/Guardian Signature* MM slash DD slash YYYY Digital Signature of Parent/Guardian* Reset signature Signature locked. Reset to sign again Name of Student* First Last Date of Student Signature* MM slash DD slash YYYY Digital Signature of Student* Reset signature Signature locked. Reset to sign again EmailThis field is for validation purposes and should be left unchanged.