SIS - Spirited In Success

Mentee Information

First Name

Last Name

Date of Birth

Grade

Phone Number

Address

School

Parent/Guardian Information

First Name

Last Name

Phone Number

Address

Email

Emergency Contact (Name, phone number and relationship)

Additional Information

Please list any health concerns, restrictions, medications or allergies if applicable

Please list any strengths, concerns, or needs for your child

I am the parent/guardian and I give permission for my child to join SIS. I also give consent for SIS to use my child's photo/likeness for promotional use (i.e. website, banners, flyer, video, etc.)

Enrollment Form

Mentee Information

Parent/Guardian Information

Additional Information