Session Program Enrollment Form

Session Program Enrollment

The heart of our program is to provide a safe place for youth to experience the hope, healing, and love of Jesus Christ.
We offer our mentorship program every winter, spring and fall in 11 week blocks. Each block consists of one session a week for a continuous 11 weeks (holidays excluding).

Your youth(s) will be thoughtfully paired with a mentor for all 11 weeks. During this time they will walk alongside a mentor who will grow with them as they experience God’s love through his creation and a mentoring relationship. Each session is equipped with activities with or without animals, life skill opportunities, chores around the farm, etc. Each session includes a time of devotion to encourage youth with the hope and love of Jesus Christ.

If you are interested in enrolling your child, please fill out the form below to get the process started. Once enrollment is done, staff will contact you with next steps!
Information
Youth's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*
Grade*
Age*
Parent /Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact *

First NameLast Name
Relation to Youth *
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Health Card Number *
Medical Notes - Dietary restrictions, allergies or any other relevant medical information that would affect the participation in the program.*
Yes
Signature*

Clear
Date*

MonthDayYear
Date

Session Program Enrollment

Information

Enrollment

Session Availability

THANK YOU FOR ENROLLING!