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2. 
4. Military Service Person
6. First Name*
7. Last Name*
9. Enlistment Date (MM/DD/YYYY)*
10. Anticipated Date of Discharge (MM/DD/YYYY)*
12. Branch of Service*
    -- Select One --U.S. Air ForceU.S. ArmyU.S. Coast GuardU.S. MarinesU.S. National GuardU.S. NavyU.S. Space Force
16. Sponsor Contact Information
18. First Name*
19. Last Name*
21. Address1*
23. Address2
25. City*
26. State*
27. Zip
29. Phone Number*
30. Email Adress*
32. Relationship to Service Person*
36. Photo
38. A 5x7 or larger colored photograph of the service person in uniform must be provided. Please do one of the following:
40. Printed Photo - bring a 5x7 or larger photo to the Chino Hills Community Center. Staff will scan the image and return it to you.
42. Digital Photo - upload a .jpeg or .pdf file below
44. File Upload (.jpeg or PDF)
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field