Parent/Student Sign Up
Please fill out this information on one or more students interested in joining so we can plan their mentoring session(s). Be sure to check your email after you submit this form, as we will be in touch to set up a MentorOn session within a couple of days.  If you have any questions, please feel free email mentoronbc@gmail.com. Thank you!
Sign in to Google to save your progress. Learn more
Email *
Parent{s}/Guardian{s} name? *
City/State/Country/Time Zone?
Child's name?   *
Child's gender? *
Child's grade? *
What are your child's academic and other interests? *
2nd Child's name?
2nd Child's gender
Clear selection
2nd Child's grade?
Clear selection
What are your child's academic and other interests?
Is there anything else that we should know about your children?
Select all that apply (if you have another extenuating circumstance that demonstrates high need, please explain in "Other"). Your response will remain completely confidential. *
Required
We intend to serve as many students as possible, but especially those from disadvantaged backgrounds who cannot financially access other sources of support, or who are struggling with challenging circumstances. Please elaborate on your situation below, as this information will be used to determine matching priorities. *
Do you affirm that you are the parent/legal guardian of this participant? *
Required
By checking the boxes below, I agree to the MentorOn Terms of Service and Privacy Policy.   *
Required
For students under 18 years of age, parental consent is required. Please ask a parent/guardian to provide an electronic signature (First, Middle, Last Name) below: *I, the undersigned legal parent/guardian of the above named child, do hereby authorize MentorOn to engage in communication with my child (via video/phone call and e-mails, including Zoom/Google Meets). I acknowledge that I or another parent/guardian must be present during all tutoring/mentoring sessions and have contacted mentoronbc@gmail.com if alternatives are needed. My electronic signature (Write Name below) indicates that I agree to these conditions to participate in MentorOn: *
Times that work for a mentor session by zoom (check all): *
Required
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.