WPAL Mentee Application

Youth Mentee Application

Applicant Personal Information

All WPAL Boxers are required to complete and return a Physical Examination Form. Boxers will be required to submit the Physical Examination Form at the end of the application process.

Are you a WPAL Boxer?

Choose Your Gym

First Name

Last Name

Parent/Guardian Phone

Youth Phone

Address

City

State

Zip Code

Race

Ethnicity

Birthday

Grade Year

Free/Reduced Lunch Status

Height

Weight

Gender

School Attending:

Special Education/Disability

Previous PAL Member

Referred by

If Referred By Other, who?