Enroll A Child : Community Youth Mentoring

Enroll a Child

We are currently enrolling children ages 6-14. Please complete all required fields and an enrollment specialist will be contacting you in a few days with the next step in the enrollment process. Once the enrollment process is complete, children will be placed on our "Ready to be Matched" list to wait for their mentor. The child will be matched with a mentor who best fits the child's personality, interests and lifestyle.

Child's First Name (Required)

Child's Last Name (Required)

Child's Gender

Female
Male

Child's Age (Required)

Child's Birthdate (Required)

Child's School

Child's Grade

Parent/Guardian's First Name (Required)

Parent/Guardian's Last Name (Required)

Parent/Guardian's Phone Number (Required)

Type of Phone Number

Home
Mobile
Work

Parent/Guardian's Address (Required)

Parent/Guardian's City, State and Zip Code (Required)

Parent/Guardian's Email Address (Required)

h7xogb817gum

Confirm Parent/Guardian's Email Address (Required)

Best Way to Reach Parent/Guardian

Phone Call
Text
Email
Mail