Middle School Chattanooga 1 House and Senate Registration Form

Please only submit one form per team. You must have all of your team members' information before you can fill out this form. Please provide valid email addresses or you will be unable to complete the registration process.

Please ensure that you select the appropriate chamber (Red or Blue, House or Senate).Red Chambers are for 8th graders and/or experienced 7th graders. Blue Chambers are for 6th graders and/or inexperienced 7th graders.

Chamber:

School:

Bill teams will consist of 1-4 students. Please use a 2:1 ratio of House to Senate teams-2 House teams for each Senate team registered.

NOTE: Please use the following format for phone numbers: (123)SPACE456-7890


Student One:

First Name: A value is required.

Last Name: A value is required.

Gender: Please select an item.

Address: A value is required.

City: A value is required.

State: A value is required.

Zip: A value is required.Invalid format.

Please select an item.

Cell Phone: A value is required.Invalid format.

Grade: Please select an item.

Parent Name(s): A value is required.

Home Phone: A value is required.Invalid format.

Parent Email: A value is required.Invalid format.

Parent Cell Phone: A value is required.Invalid format.

 

Student Email: A value is required.Invalid format.

Years at YIG (if first year put 1)

Student Two:

First Name:

Last Name:

Gender: Please select an item.

Address:

City:

State:

Zip: Invalid format.

Cell Phone: Invalid format.

Grade: Please select an item.

Parent Name(s):

Home Phone: Invalid format.A value is required.Invalid format.

Parent Email: Invalid format.

Parent Cell Phone: Invalid format.

Please select an item.

Student Email: Invalid format.

Years at YIG (if first year put 1)

Student Three:

First Name: A value is required.

Last Name: A value is required.

Gender: Please select an item.

Address: A value is required.

City: A value is required.

State: A value is required.

Zip: Invalid format.A value is required.Invalid format.

Cell Phone: Invalid format.A value is required.

Grade: Please select an item.

Parent Name(s): A value is required.

Home Phone: Invalid format.A value is required.

Parent Email: Invalid format.A value is required.Invalid format.

Parent Cell Phone: Invalid format.

Please select an item.

Student Email: Invalid format.A value is required.Invalid format.

Years at YIG (if first year put 1)

Student Four

First Name: A value is required.

Last Name: A value is required.

Gender: Please select an item.

Address: A value is required.

City: A value is required.

State: A value is required.

Zip: Invalid format.A value is required.Invalid format.

Cell Phone: Invalid format.A value is required.

Grade: Please select an item.

Parent Name(s): A value is required.

Home Phone: Invalid format.A value is required.

Parent Email: Invalid format.A value is required.Invalid format.

Parent Cell Phone: Invalid format.

Please select an item.

Student Email: Invalid format.A value is required.Invalid format.

Years at YIG (if first year put 1)

You may need to wait up to 1 minute for your form to process, please do not click submit more than once.

Please note, the information contained in this form will be sent for verification to all of the email addresses (parent and student) provided in the form above.

After pressing submit, scroll up to see if you have incorrectly completed any fields (they will be highlighted in red)