Mentee Registration Form

MENTEE REGISTRATION

S.Y. 2025-2026
Student Full Name*

First NameMiddle NameLast Name
Parent Full Name*

First NameMiddle NameLast Name
Parent's E-mail*
Parent's Mobile Number*
Birth Date*

MonthDayYear
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Person to contact in case of emergency:*
Parent/Guardian
Relationship to child*
ex. Father, Mother, etc.
Phone number of emergency contact*
School Name*
Grade Year Level*
for Incoming S.Y. 2022-2023
Extra Curricular Participation*

Student CouncilClass OfficerClub/OrganizationVarsity PlayerOthers (please specify below)Other
Transportation*

Own vehiclePublic transportationSomeone else drivesNoneOtherOther
Skills/Talents*

ActingArts/CraftsCalculatingDancingDebatingDrawingEatingFashionPhotographyPlaying drumsPlaying guitarPlaying pianoProgrammingSingingWritingOthers (specify below)
Other Skills/talents
Sports*

FootballBasketballCheerleadingChessHockeySoccerSoftballSwimmingTrack and FieldTennisVolleyballOthers (specify below)
Other Sports
Interests*
What do you expect to gain out of ID2C this school year?
Question for the student: What would you like to do during the school year 22-23 while at mentor?
Describe your child in 3 words:
Parents; Would you like to volunteer at least 2 hours per month? If, so please indicate your avaliablity.
We provide snacks/dinner during our mentor days. Does your child have an food allergies that ID2C need to be aware of?
Does your child have any allergies/medical condition(s) that ID2C need to be made aware of? Please describe:
Additional Comments:
Registration Fee $50.00 per mentee

In Person on Sept 12 ( cash )
Should be Empty:

MENTEE REGISTRATION