AMERICAN LEGION AUXILIARY
Department of New Hampshire
GRANITE GIRLS STATE
Application
Franklin Pierce University
June 22 - June 28, 2008
PLEASE COMPLETE THIS ENTIRE APPLICATION AND RETURN TO THE ADDRESS LISTED ON THE BACK PAGE ALONG WITH A SMALL "HEAD & SHOULDERS" PICTURE (WALLET SIZE). EACH APPLICANT MUST ALSO INCLUDE A $30.00 NON-REFUNDABLE PROCESSING FEE.
(Print or type - using name desired on records)
Name: ____________________________________________________________________________________
(Last Name) (First Name) (Middle Name)
Home Address:_____________________________________________________________________________
(Street) (City) (Zip Code + 4)
Age: _____________ Home Telephone Number: ____________________________________
Email address: __________________________________________________________________
Name of Parent or Guardian: ________________________________________________________
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SCHOOL RECORD
Name of school attending
______________________________________________________________________________
Current GPA: _______________________________
Signature of school Principal or Guidance Director: _____________________________________
Signed this _________ day of _______________, 2008
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Are you informed on the general idea of GIRLS STATE? ___________
Have you studied civics/American Government? __________
What special talents do you have? i.e. musical, art, dance, etc.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
What extra curricular activities do you participate in?
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
Do you have disabilities? ________ If so, state nature of disability ____________________________________
_________________________________________________________________________________________
Do you recite the Pledge of Allegiance to the Flag when the opportunity arises? ______________
The undersigned parents (surviving parent or guardian) of _________________________ a student
(Applicant's name)
at ______________________________________.
(High School)
In consideration of instruction and training to be given to _________________________ as a citizen of
(Applicant's name)
GRANITE GIRLS STATE, American Legion Auxiliary, Department of NH, Inc. to be held at Franklin Pierce University during the dates of June 22 - June 28, 2008, do hereby give consent for her to participate in any activities which are scheduled as part of the GRANITE GIRLS STATE program. We do hereby release and discharge the American Legion Auxiliary, Department of New Hampshire, Inc., its officers, agents, instructors and employees from any and all claims, demands, damages, suits, actions or suffers by _________________________ while in attendance at said GRANITE GIRLS STATE, no matter how caused or
(Applicant's Name)
occasioned.
Does your daughter have any allergies or any physical or emotional conditions that GIRLS STATE should be aware of?
Yes _______ No _______ if yes, please explain __________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
______________________________
(Parents or Guardian's Signature)
Signed this _________ day of _______________, 2008
PHOTO/Likeness Release Form
I hereby authorize the staff of GRANITE GIRLS STATE to photograph or video me/my daughter and consent to the use of any/her likenesses in any and all GRANITE GIRLS STATE publications, educational material, and advertising, news media, video, and web materials.
I understand and agree that such materials, including all negatives shall become the property of GRANITE GIRLS STATE. I further understand and agree that these materials may be kept on file for potential future uses and further agree to release GRANITE GIRLS STATE from any and all liability arising from or in connection with the taking, use, publication, or dissemination of such materials.
Print Name: __________________________________
Applicant Signature: _____________________________
Parent/Guardian Signature: ______________________________
As a citizen of GRANITE GIRLS STATE, you should keep the following pledge in mind so that there will be an understanding of both the principles of GIRLS STATE and your obligations as a citizen of GIRLS STATE. As a citizen of GIRLS STATE of the American Legion Auxiliary, Department of New Hampshire, I voluntarily make the following pledge:
I will obey the rules of GIRLS STATE.
I will be present for every portion of the GIRLS STATE session.
I will take a serious and conscientious interest in discharging my duties as a citizen of GIRLS STATE.
I understand that this is an Americanism program and that it is a study of town, city, county, and state government.
I will salute the American Flag.
If elected to office, I will serve that office to the best of my ability.
I will abide by the judgment of those responsible for this Americanism program.
I will make a formal report (written or oral) of my impression of GIRLS STATE upon my return home.
I will live in residence as a citizen of GIRLS STATE and I will remain for its entirety.
In so far as possible, I will take an active part in the affairs of the party, the town, the city, and county to which I am assigned.
I will be fair and honest in all of my dealings with my fellow citizens.
I am not a member of and do not subscribe to the principles of any group opposed to our form of government.
Applicant's signature _________________________________________
Local American Legion Auxiliary Contact Information
Unit Number: __________________________
Contact Name: _________________________
Street Address: _____________________________
Town/State/Zip: _______________________
Phone: _____________________________
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FOR OFFICE USE
Sponsored by: ______________________________________________________________________________
(Unit Name and No.) (Unit President)
Contributing Sponsor: _______________________________________________________________________
Assigned to: _______________________________________________________________________________
(Party) (District) (Town, City, County) (Room)