SUIT UP! Life Skills & Mentor Summer Program Enrollment Form

Life Skills & Mentor Program

SUMMER REGISTRATION 2024
STUDENT INFORMATION:
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Name of School*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Particular Areas of Improvement
Details

Program Cost

USD$25.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty: