Child Registration Form

Thank you for your interest in enrolling your child in our Mentoring Program. This program is designed to support male youth by connecting them with positive mentors and providing valuable life skills. Please complete the form below to sign your child up for this program.
Child's Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child Age:
Race:

WhiteBlack or African AmericanAsianNative AmericanOther
Grade:
Parent/Guardian Name:

First NameLast Name
Relationship to Child:
Contact Number:
Please enter a valid phone number.
Email Address:
example@example.com
Emergency Contact Name:

First NameLast Name
Emergency Contact Number:
Please enter a valid phone number.
Does your child have any medical conditions or allergies we should be aware of?
What are your child's interests or hobbies?
Is there any additional information you'd like to share with us?
By signing below, I hereby give my consent for my child, (above name), to participate in the mentoring program provided by Order of Solomon. I understand that this program involves volunteering and mentoring opportunities, which may include transportation to various locations, interaction with staff or mentors, and participating in different activities.

I acknowledge that the program organizers will take reasonable precautions to ensure my child's safety and well-being. I release Order of Solomon, its staff, volunteers, and affiliates from any liability or responsibility for accidents, injuries, or other unforeseen circumstances that may occur during my child's participation in the program.

By signing this form, I confirm that I have provided accurate information and give my full consent for my child to participate in the program as outlined.
Date

MonthDayYear
Date
Parent/Guardian Name:

First NameLast Name
Signature:

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Thank you for helping us make a positive impact in your child's life! We look forward to working together to make this a rewarding experience.
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