ALL INFORMATION IS REQUIRED. THIS APLICATION REQUIRES A PARENT/GUARDIAN SIGNATURE.

1. Parent/Sponsor/Guardian Information: ( ( ) ) - - ALL INFORMATION IS REQUIRED. THIS APLICATION REQUIRES A PARENT/GUARDIAN SIGNATURE. PLEASE RETURN COMPLETED APPLICATIONS TO: West Virginia National Guard Family Programs 1703 Coonskin Drive Charleston, WV 25311 CONTACT RICHARD SWITZER @ (304)561-6828 Richard.Switzer4@us.army.mil with any questions Applicant Information: Name: Last First Middle E-Mail Address Gender: Female Male Date of Birth: (Example: 28/01/1989) Street Address: City, State, Zip: / / Full Name w/Rank (Last, First, Middle, Rank): Military Unit/Status: Daytime Phone Number: Evening Phone Number: E-Mail Address: Parent/Guardian Permission I hereby authorize ____________________________________ (applicant’s name), to apply for the position of Operation: Military Kids (OMK) Youth Advisor. My signature on this document also allows West Virginia National Guard Youth Programs, OMK, and 4-H to use photographs, voice, and/or video of my child for Public Relations purposes. ____________________________________________________ __________________________ (Parent/Guardian Signature (REQUIRED) Date