YOUTH EMPOWERMENT AND MENTORSHIP Program & Sports Tournaments
An Anti-Racism Pilot Project
Sports Tournament Registration Form
Thank you for your interest in being part of this re-imagine youth on the road mentorship and empowerment through sports. Registration is Free. Min. 4 players- Max. 10 players and must include one female. Should your team not include a female, preference will be given to teams that has a female. Questions? Please contact Program Director elshamaconsulting@gmail.com. We look forward to seeing you. Pizza Water Trophies for Winning Team. Please join us on May 3rd at 12-2Pm for the Program Launch. Lots of prizes and give aways.
Name
First Name
Last Name
What age group do you belong to?
*
13 - 15
16 - 18
19 - 20
21 - 24
Date of birth
-
Month
-
Day
Year
Date
Gender
Male
Female
What School / Organization you attend
WHICH GROUP DO YOU BELONG TO?
*
BLACK CANADIAN (born in Canada)
BLACK IMMIGRANT CANADIAN
INDIGENOUS
WHITE CANADIAN
ASIAN Indian
NEW COMER TO EDMONTON
OTHER
ASIAN Other
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Relationship to Participant
*
Emergency Contact Number
*
Please enter a valid phone number.
Back
Next
Back
Next
Please indicate what Sport(s) and event you are Registering for
*
Program Launch - May 3rd - 12Noon - 2PM - Meadows
Basketball Kick off - May 3rd 2PM - 6PM
Badminton - May 17th - 2PM - 6PM
Volleyball- May 31st - 2PM - 6PM
Shirt/Jersey Size
Do you agree to be Randomly place on a team with other registrant
*
YES
NO
Any Medical Conditions or Allergies
*
Special Accommodations Needed
*
How did you hear about the tournament?
*
If you were to be apart of a mentorship program, what would make you feel comfortable?
*
The leaders look like me
The leaders are successful in their life
The leaders come to me
The leaders listen without Judgement
There is a small group of other youth
I have one - one sessions
I would never join a mentorship program
I have friends in the group
If you were to be apart of a mentorship program, what would be your goal?
*
Career Development/ Graduation coaching
Skill Enhancement - Life skills
Building self-esteem/ increased confidence
Network Building
Development of personal resilience / Personal growth
Gaining insights from a mentor's experience
Improved Decision-Making
Date signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: