Kamp Khalil Mentorship Registration Form 
In a continued effort to offer services throughout the year, we are providing in-person and online mentorship sessions for youth ages 12-17. Please complete the registration form to benefit from this opportunity.
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Email *
Youth First Name *
Youth Last Name *
Youth Date of Birth  *
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/
DD
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Youth Age *
Parent/Guardian Name  *
Parent/Guardian Cell Phone # *
Youth Availability (Check All that Apply) *
Required
Mentorship Areas (Check All that Apply) *
Required
Youth Interest/Hobbies  *
Questions/ Comments
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