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Name of Child (required)

Age (required)

Grade (required)

School (required)

Language(s) spoken (required)

Parent (required)

Name of Parent (required)

Address (required)

Home/Cell Phone (required)

Your Email (required)

Please indicate your preferred method of communication

Please indicate the best time to contact you
Between 9:00-12:00Between 1:00-6:00

Please select the mentoring workshop(s) you wish to inquire about or sign up for: (required)
Club Membership Fall 2020

How would you describe your child? What are their needs? Please indicate any information that can be helpful and/or relevant for the purpose of our workshops: (required)