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4. Monterey Park Civic Superstar

   Now taking volunteer applications for Monterey Park students, 1st-5th grade, to lead the Pledge of Allegiance during a regular City Council meeting. Please complete the form below. Only one student per regular meeting date will be randomly selected. Must be a resident.

6. Child's First Name*
7. Child's Last Name*
9. Child's Grade*
   -- Select One --1st Grade2nd Grade3rd Grade4th Grade5th Grade
10. Child's School*
12. Is the child comfortable with speaking in front of large audiences?*
    -- Select One --YesNo
13. Is the child a resident of Monterey Park?*
    -- Select One --YesNo
14. Child's Address*
16. Parent/Guardian First Name*
17. Parent/Guardian Last Name*
19. Parent/Guardian Phone Number*
20. Parent/Guardian Email*
22. Please select a date:

    Please select a date that would work best for your Civic Superstar to lead the pledge of allegiance. You will be contacted to confirm your date or change your date, depending on applicants. Only one student will be selected per meeting. Your Civic Superstar must arrive by 6:15pm for the 6:30pm meeting.

24. City Council Date First Selction*
    -- Select One --January 2, 2024 - 6:15pmJanuary 17, 2024 - 6:15pmFebruary 7, 2024 - 6:15pmFebruary 21, 2024 - 6:15pmMarch 6, 2024 - 6:15pmMarch 20, 2024 - 6:15pm
25. City Council Back-Up Date Selection*
    -- Select One --October 4, 2023 - 6:15pmOctober 18, 2023 - 6:15pmNovember 1, 2023 - 6:15pmNovember 15, 2023 - 6:15pmDecember 6, 2023 - 6:15pmDecember 20, 2023 - 6:15pm

    If your first selection is not available, please select a backup date.

Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field