She Builds HER NEXT — Mentee Enrollment Form
Thank you for your interest in She Builds HER NEXT! 💗 She Builds HER NEXT is a mentorship program for girls ages 10–17, created to provide a safe, encouraging space where girls can grow in confidence, character, leadership, life skills, faith, and community. Please complete this enrollment form for your daughter. This information helps our team learn more about her and prepare for a meaningful mentorship experience.
Parent/Guardian Information
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Sibling
Foster Parent
Guardian
Other
Email Address
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Home City
*
ZIP Code
*
Preferred Method of Communication
*
Please Select
Phone Call
Text Message
Email
Other
Mentee Information
Mentee Full Name
*
First Name
Last Name
Preferred Name / Nickname
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
Current Grade
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
School Name
*
Shirt Size
*
Please Select
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Other
Get to Know Her
How would you describe your daughter’s personality?
What do you see as her strengths?
What does she enjoy doing most?
What are her hobbies or interests?
In which areas would you most like her to grow?
*
Confidence
Leadership
Communication
Academic Skills
Social Skills
Goal Setting
Self-Advocacy
Independence
Other
Mentorship Needs
Why are you interested in enrolling your daughter in She Builds HER NEXT?
*
What would you like your daughter to gain from having a mentor?
*
Has your daughter participated in a mentorship program before?
*
Yes
No
Not sure
Is there anything else mentors or the Program Director should know about your daughter?
Mentee Voice
What are three things you like about yourself?
*
What is something you would like to become more confident about?
*
What is one goal you have for yourself this year?
*
What are you most excited to experience in She Builds HER NEXT?
*
Is there anything you wish adults understood better about girls your age?
Program Commitment
Can your daughter regularly participate in scheduled program activities?
*
Yes
No
Are you willing to support consistent attendance and participation?
*
Yes
No
Transportation & Pick-Up
Authorized Pick-Up Person #1
*
First Name
Middle Name
Last Name
Authorized Pick-Up Person #2
First Name
Middle Name
Last Name
Will transportation generally be available for your daughter to attend activities?
*
Yes
No
Sometimes
Not sure
Emergency & Safety Information
Emergency Contact Name
*
First Name
Last Name
Relationship to Child
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Emergency Contact
Does the child have any allergies, dietary restrictions, accessibility needs, or other safety-related information we should know?
*
Yes
No
Please explain any relevant safety or support needs
Program Policies & Parent Agreement
Agreement Statements
*
Completion of this enrollment form does not automatically guarantee placement
I agree to keep She Builds HER NEXT informed of updated contact and emergency information
I understand the importance of consistent attendance and communication
I agree that my child will follow the organization's behavioral expectations and safety policies
I understand that additional permission forms may be required for field trips, transportation, volunteer activities, or special events
I certify that the information provided is accurate
Parent/Guardian Electronic Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Acknowledgment
Printed Name of Parent/Guardian
*
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Relationship to Mentee
*
Back
Next
Photo Permission
Please review the photo permission information before continuing.
Do you give permission to take photos during this process?
*
Yes
No
Submit
Submit
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