Youth Application – Leadership Hot Springs

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Your Name *

First

Middle

Last

Your Email *

Your Primary Phone *

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian Name *

First

Last

Parent/Guardian Phone *

Name of School *

Grade *

Your upcoming year.

Main area of interest in studies: *

Current vocational goal: *

Period of time you have lived in Garland, Co. *