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Kings Creating Kings Student/Mentee Enrollment Form
Please complete this form with mentee/student information.
* Indicates required question
Email
*
Record my email address with my response
Student/Mentee Name (Last Name, First Name)
*
Your answer
T-shirt Size
*
Your answer
Sex
*
Male
Female
Birthdate
*
MM
/
DD
/
YYYY
School Name
*
Your answer
Homeroom Teacher (If Applicable)
Your answer
Parent/Legal Guardian Name(s)
*
Your answer
Street Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Home Phone
*
Your answer
Cell Phone
*
Your answer
Email Address
*
Your answer
When group programs/events end (please check one
*
I will pick up my child.
My child will require transportation.
My child can walk home.
My child will be picked up by emergency contacts (listed below).
Required
I authorize the following people to be contacted in case of an emergency (when parents cannot be reached) and to pick up my child:
*
Your answer
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