Hardin County Kappa League Application

Fort Knox Alumni Chapter

Student Name *

First

Middle

Last

Street Address

Street Address 2

City, State

Postal Code

Phone Number

Numbers only. Include area code

Date of Birth (mm/dd/yyyy) *

Email Address *

Email

Confirm Email

School Name *

Years in Kappa League *

0
1
2
3
4

0 = New Member

Shirt Size *

Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
XXL

if is not listed please provide size

Hobbies / Interest

Sports, Band, Gaming

Guardian 1 Name *

First

Middle

Last

Street Address 1 *

Street Address 2

City, State *

Postal Code *

Phone Number *

Email Address *

Email

Confirm Email

Guardian 2

Street Address 1

Street Address 2

City, State

Postal Code

Phone Number

Email Address

Photo Release *

I give permissions to Fort Knox Alumni Chapter of Kappa Alpha Psi Fraternity Inc. and the Hardin County Kappa League to use or release photos my child taken for the purpose Fraternity.

Grades and attendance *

By checking this box I authorize the Hardin County Advisors to access my Childs grades and attendance

Questions /Comments /Food Restrictions

Phone