Adult Participant Application

First Name *

Last Name *

E-Mail Address

Physical/Mailing Address *

City *

State *

Zip *

Date of Birth Month/Day/Year *

Home Phone *

Work Phone

Cell Phone

Gender *

T-Shirt Size *

Social Security Number (Optional for OAD Reporting)

Ethnicity (Optional for OAD Reporting)

Parish Where You Live *

School/Organization *

Team Name

Why do you want to attend GOT? *

What prevention projects have you been involved in? *

Is your personal image consistent with a non-drinking, non-drugging image? Explain.

I understand that I will be responsible for recruiting and bringing 6 - 12 high school youth to the training. *

I understand that GOT is a training and I will be coming to learn about making a difference in my community. *

I understand that I will be expected to work with students following the training to implement strategies in the communuty. *

I have strong beliefs in the drug-free message. *

I have read and agree to abide by the rules and ethics at GOT *

If you don't agree to the above statements, GOT may not be the right training for you. Explain any special concerns about the statements here.