Sihle Registration Name* First Last Nick NameDate of Birth* Date Format: MM slash DD slash YYYY Age*Future Life Goals(this will help us match you for the Sista to Sista Monitoring Experience.)Address* Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Phone Number*Current School*Current Grade*Email* Allergies*YESNOIf YES Please Specify*Parent ContactMother's Name* First Last Mother's Email Mother's Phone NumberFather's Name* First Last Father's Email Father's Phone NumberEmergency ContactEmergency Contact Name* First Last Emergency Contact Number*Emergency Contact Relationship*ALL MEMBERS ARE Sihle participants are expected: Remain with the group at all times. Be respectful to all in attendance. Follow the Sihle Guidelines as posted in the youth room. Attend all Sihle Sesions to reap rewards. My parents understand the guidelines above and realize, if violated, actions deemed necessary by the STAFF will be taken which may include parental contact. EmailThis field is for validation purposes and should be left unchanged.