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Assisteens Application and Dues
Assisteens Applicant Information
First
(Required)
Last
(Required)
Preferred Name or Nickname (optional)
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Assisteens Email
(Required)
Assisteens Primary Phone
(Required)
Secondary Phone
School Name
(Required)
Grade 2024-25
(Required)
Assisteen Birthdate
(Required)
Month
Day
Year
Gender
(Required)
Male
Female
Other
Prefer not to answer
New or Returning to Assisteens?
(Required)
New Assisteen
Returning Assisteen
Please tell us a little more about you!
How did you hear about Assisteens?
What are some of your skills, hobbies, or interests?
Is your parent or grandparent a member of Assistance League?
(Required)
Yes
No
What is the member's name?
First and last Name
Parent/Guardian Information
Parent/Guardian Name
(Required)
First and last name
Primary Phone
(Required)
Secondary Phone
Parent/Guardian Email
(Required)
Secondary Parent/Guardian Name
First and last name
Primary Phone
Secondary Phone
Secondary Parent/Guardian Email
Does the secondary parent/guardian want to receive an email notification of meetings?
Yes
No
Emergency Information
EMERGENCY CONTACT (if different than Parent/Guardian above)
Primary Phone
Secondary Phone
Emergency Contact Email
Relationship
Code of Conduct - Read and Sign
I understand that my attitude and behavior are critical to the success and reputation of the Assisteens Auxiliary. For the good of the organization and my fellow Assisteens, I agree to abide by the following:
will fulfill the expectations of my membership in accordance with Policies of Assisteen Auxiliaries. I will conduct myself in an appropriate manner at all times while participating in Assisteens activities.
I will respect fellow Assisteens members and all those with whom I come in contact through Assisteens programs and events.
I understand that bullying and harassment will not be tolerated and may result in revocation of membership.
I understand that the use of tobacco, alcohol, drugs or gambling will not be tolerated at any Assisteens activity, and may result in revocation of membership.
I understand that use of electronic devices during meetings is prohibited. I also agree that I will carefully consider any material placed on the internet or posted in any form of social media in order to preserve and protect the name, image and reputation of Assistance League and Assisteens. I further understand that posting of inappropriate photos or videos will not be tolerated and may result in revocation of membership.
I understand that if I am sent home early due to any misconduct or illness, it will be at the expense of my parent/guardian. In case of such an occurrence, the supervising adults will contact my parent/guardian and will, if necessary, make the travel arrangements.
I understand that if I need to leave an Assisteens activity before it is over, I will notify the adult in charge.
Assisteens E-Signature
(Required)
I acknowledge I have read and agree to abide by the Code of Conduct for the Assisteens Auxiliary.
Payment
Assisteens Membership Dues
Price:
Credit Card
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