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REGISTRATION

Registration

2021 REGISTRATION 

Due to US Covid restrictions, space is very limited!!  Fill out the form below for enrollment and a member of our staff will be in touch with you. 

FEES:

$25 Registration

$15 CBBMP T-Shirt

CHILD INFORMATION

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Child T-Shirt Size (check one)

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

If yes, explain

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

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?

EMERGENCY CONTACT INFORMATION

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