Timoteo Sports Mentoring Form

Name of Child:*

Age of student:*

Date of Birth of student:*

MonthDayYear

School student attends:*

Grade of student:*

How can we work with you?

Does the student have a diagnosed learning disability?*

YesNo

Please list any allergies that the student may have:

Please list any medical condition the student may have:

Is there anything else we need to know about the student that will help us to provide the optimum experience?

What are some of your goals?

Think: 5month, 1 year, 5 years.

What is your favorite thing to do?

What is your expectation from your mentor?

What would you describe yourself as? (Ethnicity)

Latino/HispanicNon-Latino/Hispanic

Which of the race designations below best describes you?

In the past 6 months, have you had difficulty meeting any of your basic needs such as food, housing, transportation, utilities or personal safety?*

YesNoPrefer not to answer

If "Yes", which of the following needs have you had difficulty meeting(select all that apply)

Mother's/Father's Name:*

First NameLast Name

Telephone Contact - Home:*

Area CodePhone Number

Telephone Contact - Work:*

Area CodePhone Number

Telephone Contact - Cellular:*

Area CodePhone Number

Email address:*

Has your student participated in the tutoring/mentoring through Timoteo Sports before?

On Wednesdays between 4:00pm and 5:30p.m, Timoteo Sports offers mentoring for 7th grade to high school-aged students. The Timoteo youth basketball league runs on Saturdays from 9:00am to 12:00pm at Esperanza College, located at 4261 N 5th st. At our core, Timoteo Sports is a mentoring and youth discipleship program. While coaching and player interactions on the field remain central to our mission, we’ve developed several key initiatives to provide additional support. Our “More Than Sports” initiatives reflect our belief that youth need more than just trophies and highlight reels—they need holistic support that nurtures their academic, physical, emotional, spiritual, and career growth. We partner with organizations that share our commitment to young people. A responsible adult is required to drop off students at The House of Hope, located at 1300 W. Hunting Park Ave. Children must be signed in and out by their parents or legal guardians.

By participating in Timoteo Sports programs, including mentoring sessions and the youth basketball league, parents or legal guardians of participants grant Timoteo Sports permission to use photographs, videos, or other media capturing their child’s likeness for promotional, marketing, or informational purposes. This includes, but is not limited to, use on the Timoteo Sports website, social media platforms, and printed materials.

During the summer months, dates, times, and locations are subject to change. Email Josue Garcia at Josue@timoteoSports.org for information about summer dates and times.

Name of Person that will be collecting child:*

Name of person completing this form:*

First NameLast Name

Relationship to Child:

E-mail address of person completing this form:*

Mentoring Registration Form

Parent Information