After School Program Enrollment Form

Grace to Grow Program Enrollment Form

2025 - 2026
Welcome to the Grace to Grow Youth Mentorship Program!

We are excited that you are interested in enrolling your child. Our program provides academic support, positive mentorship, and leadership opportunities for school-age children.

This form will help us get to know your child better so we can match them with the right mentor and ensure they receive the best experience possible. Please answer all questions honestly and completely. All information will remain confidential and will only be used for program purposes.

Section 3: Academic & Mentorship Needs
What subjects does your child need the most help in?*

ReadingWritingMathScienceOther
What are your child’s strengths?*
What areas would you like to see your child grow in?*
Has your child ever participated in a mentorship or tutoring program before?*

YesNoType option 3Type option 4
If Yes, please describe.

Section 5: Emergency Information
Emergency Contact Name*
Emergency Contact Phone Number*

Area CodePhone Number
Does your child have any allergies, medical conditions, or special needs we should be aware of?*
If none, enter N/A.

Section 6: Permissions & Consent
I give permission for my child to participate in the Grace to Grow Youth Mentorship Program.*

Yes
I give permission for photos/videos of my child to be used for program promotion.*

YesI would like to review prior to useNo
Parent/Guardian Signature *

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Thank you for enrolling your child in the Grace to Grow Youth Mentorship Program! We are honored to walk alongside your family in this journey of growth and support.

You will receive a confirmation email within 3–5 business days with next steps, including your child’s mentor match, program orientation details, and start date.

If you have any questions, please contact us at:
📧 info@gracedtoserve.org | 📱 (334) 722-1684

We look forward to partnering with you and your child! 💙
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Grace to Grow Program Enrollment Form