Youth Rally Application Form

2026 Youth Rally Application

By completing this form, I agree that I am interested in and available to attend the 2026 Youth Rally.

Applicant's Name(Required)

First Last

Applicant's Phone Number(Required)

Please enter a valid phone number.

Applicant's Email Address(Required)

example@example.com

Applicant's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Applicant's Date of Birth(Required)

Current Grade(Required)

Applicants must be a current sophomore or junior from a public or private secondary school or home school program within the HEA service territory.

Name of High School(Required)

HEA Member Number(Required)

HEA Member Name(s)(Required)

First Last

Parent/Legal Guardian Name(Required)

First Last

Parent/Legal Guardian Phone Number(Required)

Please enter a valid phone number.

Parent/Legal Guardian Email Address(Required)

example@example.com

Applicant's Signature(Required)

I confirm that all information entered is accurate and I have read and understand this application form and my responsibilities as an HEA Youth Rally Representative.

Parent/Legal Guardian Signature(Required)

I agree that all information entered is correct and I/we, the above-named parent(s)/legal guardian(s) have read and understand this application form, the rules of conduct, and our son's/daughter's responsibilities.