ENROL A YOUNG PERSON

CHILD INQUIRY FORM

Thank you for your interest in registering your child with Big Brothers Big Sisters of South-West Durham

To receive more information about our mentoring programs and how to register your child please complete the form below and our Intake Coordinator will give you a call to discuss the application process.

Parent/Guardian Information
Name*
First Last
Email*
City*
What is the best number to reach you at?*
CHILD INFORMATION
Child/Youth's Name*
First Last
Child/Youth's Age*

(must be between 6 and 16 years)
Child/Youth Date of Birth*
MM slash DD slash YYYY
Child/Youth Gender*
Hidden
One-to-One Mentoring Program(s) of Interest
- One-to-One Big/Little Mentoring
- Virtual Mentoring (ages 6-14)
Select any programs in which you believe suits your child best. For more information on programs visit the "Our Programs" tab under MENTORING PROGRAMS.
Group Mentoring Program(s) of Interest
- Go Girls (females ages 11-14)
- Power Play Functional Mind and Body (ages 10-15)
- Power Play Yoga (ages 10-15)
- Switch Gears 2.0 (males ages 10-14)
- The Little Studio (ages 9-14)
Select any programs in which you believe suits your child best. For more information on programs visit the "Our Programs" tab under MENTORING PROGRAMS.
Where did you hear about us?*
Comments
This field is for validation purposes and should be left unchanged.

ENROL A YOUNG PERSON

CHILD INQUIRY FORM

Parent/Guardian Information

CHILD INFORMATION