L.U.C.K.Y. Leadership Mentoring Program Registration 2022-2023
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Email *
Name of future l.u.c.k.y. parent *
Name of future L.U.C.K.Y. mentee *
Parent Phone Number *
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Parent Email *
Family Address for L.U.C.K.Y. mentee *
How old is your child? *
What grade is your L.U.C.K.Y. mentee in? *
Select location. *
During the program, we may take photos/videos/audio recordings of participants to use in promoting L.U.C.K.Y. Mentoring Program Organization in general. Do you consent to your child being photographed or recorded by us for the above purpose? *
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Please share any known allergies of your child/teen. *
Emergency Contact Name: *
Emergency Contact Phone Number *
Emergency Contact Address *
How did you find out about the L.U.C.K.Y. Mentoring Program *
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Does your child need any special accommodations of any kind? *
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