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Remote Video Production Truck Student Application
Remote Video Production Truck Student Application

Please print this page, fill it out, and return it to your instructor.

 

Name: ____________________________________________________

 

Address: ____________________________________________________________________

 

Social Security Number: ____________________________________

 

Phone Number: ____________________________________

 

Cell Phone: ____________________________________

 

Parent / Guardian Name: ____________________________________________________________________

 

Address (if different): ____________________________________________________________________

 

Home School: ____________________________________________________________________

 

Grade: ______________

 

Truck Position Desired: ____________________________________________________________________

 

Student Signature: ____________________________________________________________________

 

Date: ____________________________________

 

PARENT / GUARDIAN STATEMENT

 

My child has available transportation to and from events:   Yes     No

 

My child has medical insurance or school system's Accident Insurance:   Yes     No

 

Name of Insurance: ____________________________________________________________________

 

Parent / Guardian Name (Print Name): ____________________________________________________________________

 

Signature: ____________________________________________________________________

 

Date: ____________________________________