Student Application || Chantelle Bustamante

Student Enrollment Application

Information

First Name: CHANTELLE
Last Name: BUSTAMANTE
Birthdate: 11/04/1996
Home Address: APARTMENT 104, JEFFERSON MOTEL APTS, JEFFERSON, LOS SANTOS
Cellphone Number: 1028377
Guardian Telephone Number if Applicable: N/A
Guardian/Parent Email if Applicable: N/A

Student Signature: C. Bustamante  ____________________________________________________________________________________________

Medical Information

Major Medical Conditions: N/A
Minor Medical Conditions: Asthma
Any conditions that will need an inhalant or a pill during school: Yes; inhaler (Ventolin)
__________________________________________________________________________________________

(( Out of Character ))

First Name: Jack
Age: 21
Geographical Location & Timezone: GMT+0

Agreement

I agree to take responsibility to any roleplay, good or bad, that I do in Los Santos High School. I also agree to roleplay realistically and the best I can, and take responsibility for any brawl-provoking or any trolling, etc. I agree to accept any punishment for a rule I have broken, and to take my punishment fully. I agree to be admin kicked, admin jailed, or even banned by an administrator if necessary.

Signature: ya boy coup d'état