KAPPA LEAGUE APPLICATION

Austin Kappa League Membership Application

For young men ages 13–18. Complete this application to begin your journey with the Austin Alumni Chapter's flagship Guide Right youth program.

Applicant Information

Information about the young man applying for membership.

First Name *

Last Name *

Date of Birth *

Gender

Email *

Phone *

Street Address

City

State

ZIP

Parent / Guardian Information

Primary contact for the applicant.

First Name *

Last Name *

Relationship to Applicant

Phone *

Email *

Street Address

City

State

ZIP

Emergency Contact

Same as Parent / Guardian above

Academics

School You Attend *

GPA *

Courses You Are Enrolled in This Year

Most Enjoyable / Best Course

Least Enjoyable Course

Career Interest

Top 3 Colleges / Universities You Would Like to Attend

Interest Level

If granted membership, what are your expectations? *

Why are you interested in becoming a member of the Austin Kappa League? *

List all community organizations you are involved in

List any school activities (varsity athletics, student government, volunteer work, etc.)

Medical Information

Medical conditions or allergies we should be aware of

Hearing Problems?

Wears a hearing aid?

Vision Problems?

Wears glasses or contacts?

Has the applicant had a serious illness, injury, or hospitalization in the past year?

Has the applicant been vaccinated against COVID-19?

Emergency Medical Information

In case of emergency, where would you prefer your child be transported?

Preferred Hospital / Urgent Care Facility

Health Insurance Provider

Group / Policy Number

Primary Care Physician's Name

Physician Phone

Membership Dues

Annual Dues: $250.00 — due by August 1st. A payment of $125.00 must be received before the Induction Ceremony.

Required Acknowledgements

Each acknowledgement requires the appropriate party to type their full name as a digital signature. The submission timestamp serves as the date of signature.

News Release / Program Promotion Waiver. I give permission to the Austin Guide Right Program and the Austin (TX) Alumni Chapter of Kappa Alpha Psi Fraternity, Inc. to use or release any photos of my child, taken solely for the purpose of promoting the Fraternity and its Guide Right Program.

I, the parent / guardian, agree to the news release / promotion waiver above. *

Release for Medical Treatment. In the event of an emergency, and the inability of the Austin Kappa League staff to obtain my consent, I hereby give permission for the members of Austin (TX) Alumni Chapter of Kappa Alpha Psi Fraternity, Inc. to authorize any medical treatment or surgery which a physician or surgeon shall deem necessary for my child.

I, the parent / guardian, agree to the medical treatment release above. *

Parental Acknowledgement. I hereby give my permission for my child to become a member of the Austin Kappa League. I understand that the Austin Guide Right Program and the Austin (TX) Alumni Chapter of Kappa Alpha Psi Fraternity, Inc. is not responsible for personal injury or loss of property. I understand that the payment of yearly membership dues is required and that $125.00 will be due before the Induction Ceremony. I understand my child can / will be expelled from the Austin Kappa League at any time due to misconduct, with no monies refunded.

I, the parent / guardian, agree to the parental acknowledgement above. *

Application Acknowledgement. I wish to become a member of the Austin Kappa League and I promise to be careful to prevent damage to any buildings used while participating in activities. I agree to obey the rules and bylaws of the Austin Kappa League. I represent that all answers and information furnished are true and correct, and I understand that any incorrect or false information may result in automatic rejection. If approved, I agree to comply with the program's rules and regulations.

I, the applicant, agree to the application acknowledgement above. *

* Required fields