School Year Registration

Teen Registration Form 2018-2019


Please enter teen's information below. All fields with an asterisk* are required.






Birthdate* (mm/dd/yy):
Gender:
Ethnicity:
Other Ethnicity:





If you are a teen who identifies as LGBTQ+, are you out to your parents?:

School*:
Other School:
Estimated Graduation Year*:

Please provide full contact information for at least one parent or guardian. It is important that we have emergency contact information for all teens.

Parent/Guardian First Name*:
Parent/Guardian Last Name*:
Parent/Guardian Phone Number*:
Parent/Guardian Phone Type:
Parent/Guardian Email*:
Parent/Guardian Employer:

Parent/Guardian 2 First Name:
Parent/Guardian 2 Last Name:
Parent/Guardian 2 Phone Number:
Parent/Guardian 2 Phone Type:
Parent/Guardian 2 Email:
Parent/Guardian 2 Employer:

The following demographic questions help the Neutral Zone seek grant funding. The are optional, but we strongly encourage you to answer as best you can.


Family Income Range:
Family qualified for free/reduced lunch?:
Eligible for MI Child Health Insurance?: