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The Success Center
THE SUCCESS CENTER
TUTORING AND MENTORING
MENTORING +
VOLUNTEER WITH US
Mentoring + Registration
Students General Information
First Name
Last Name
Address 1
Address 2
Country
City
State
Zip/Postal Code
Email Address
Contact Number
Birth Date
Gender Identity
Medical Concerns/Allergies/Medications
What do you hope your child will gain from this program?
Parent / Guardian Information (Primary Contact Person)
For Participants 18 and Under. Those over 18 May skip this section.
First Name
Last Name
Email Address
Contact Number
Relation to Student
Photography Waver
By selecting "I approve" below, I hereby give permission for First Lutheran Church, and its designees to utilize photographs taken of me for the purposes of publicity on web sites, newsletters, brochures, or other media. Further, I relinquish any right to compensation for their use.
I approve
I decline
Final Verification and Submission
I verify that all the provided information is correct, and acknoladge that by submitting this form I am signing my child up to attend The Success Center: Mentoring +.
Check here to verify
Submit Registration
