TOPPS Mentee Enrollment Form

TOPPS Mentee Enrollment Form
Section 1: Student Information
Student's Name

First NameLast Name
Student's Preferred Name
Student's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student's Cell Phone (Optional)
Please enter a valid phone number.Format: (000) 000-0000.
Student's School
Student's Grade
Student's Shirt Size
Section 2: Parent/Guardian Information
Parent/Guardian's Name

First NameLast Name
Relationship to Student
Parent/Guardian's Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian's Email
example@example.com
Would you like to include a Parent/Guardian 2?
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 - Relationship to Student
Parent/Guardian 2 Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian 2 Email
example@example.com
Emergency Contact 1 - Name, Cell Phone, Relationship to Student
Emergency Contact 2 - Name, Cell Phone, Relationship to Student
Section 3: Mentoring Needs & Interests
Which mentoring program are you interested in enrolling your student in?
What areas would you like a mentor to support your child in?

Other
What are your child's interests, hobbies, or favorite activities? (Optional)
Is there anything you would like us to consider when matching your child with a mentor? (Optional)
Is there anything important we should know to help your child participate successfully in TOPPS mentoring? (Optional)
Section 4: Availability
TOPPS mentoring sessions are generally held two Sundays a month. Is your child able to attend regularly?
Is transportation to and from TOPPS mentoring activities generally available?
Section 5: Parent/Guardian Consent
I give permission for my child to participate in TOPPS mentoring activities and understand that TOPPS will make mentor assignments based on availability, program needs, and appropriate matching considerations.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: