Teen Application for Teen TrUSt Group Mentoring
Child's name
*
First Name
Last Name
Child's current address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child's preferred name on mentoring nametag
*
Child's gender
*
Male
Female
Other
Child's birthday
*
-
Month
-
Day
Year
Date
Child's current age
*
Child's primary language
*
English
Spanish
Other
Child's t-shirt size
*
Adult XS
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult XXXL
Name of caregiver
*
First Name
Last Name
Relationship to child
*
Caregiver's primary language
*
English
Spanish
Other
Caregiver's address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Caregiver's phone number
*
Please enter a valid phone number.
Caregiver's email
*
example@example.com
Child is living with:
*
Is your child assigned to a caseworker?
*
Yes
No
Does your child already have a personal Bible at home?
*
Yes
No
Has this child had any illnesses and/or hospitalization for medical or psychiatric reasons in the last year?
*
Yes
No
If yes, please explain.
Does this child use any assistive devices (hearing aids, leg/arm brace, etc.)?
*
Yes
No
If yes, please explain.
Which programs has your child participated in?
*
Royal Family Kids Mentoring (though age 12)
Royal Family Kids Camp (through age 12)
Teen TrUSt Mentoring (age 12+)
Teen TrUSt Camp (age 12+)
None of the above.
Caregiver's signature
*
Continue
Should be Empty: