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Registration

2020 Year

Registration Application Form

A one-time $25 registration fee is required.*  

$5 for each additional child

Fill out the form below for enrollment and a member of our staff will be in touch with you. 

*Please note registration fees are non-refundable. 

All registrants must attend a mandatory orientation after registering.

CHILD INFORMATION

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Child T-Shirt Size (check one)

S

M

L

XL

Does your child have any medical conditions? (check one)

Yes

No

If yes, explain

Does your child have any behavior/learning disabilities? (check one)

Yes

No

If yes, explain

List your child's special talents or interests

List three career goals of your child (one non-athletic)

How can you, the parent, assist the program in providing a pleasant experience for your child?  Do you have any special gifts, talents or abilities that you've willing to share with the program?

How do you think the Big Brother Mentor Program will benefit you and your child?

PARENT/GUARDIAN INFORMATION

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Would you like to receive program reminders via e-mail?

Yes

No

EMERGENCY CONTACT INFORMATION

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