Interested in registering for ATMN programs?

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Thank you for your interest in ATMN programs. Our goal is to provide you and your child with the best possible care in a compassionate, non-judgemental, and hope-filled environment. The following questions will help our leaders learn how we can best serve you and your child through our program. We look forward to connecting with you soon!

Email *

How did you hear about ATMN? Who referred you to us?

School

Church

Parent

Friend

Other:

Clear selection

Youth Name (first and last)

Youth Birthdate *

YYYY

Youth Gender

Female

Male

Clear selection

Grade Level

Clear selection

Youth Phone Number (if applicable)

Program Participation Interest?

Small Group Mentoring (online)

Individual Mentoring (in-person or online)

PBA- outside of school activities, mentoring, life skills, etc at ATMN Irving facility

GRACE (teen moms and teen moms to be)

Youth Drop-In Center, starting October 16th

Parent/Guardian First Name

Parent/Guardian Last Name

Parent Email

Parent Phone Number

Preferred Method of Communication

Text

Phone

No Preference- All Methods Are Okay

Clear selection

Preferred Language of Communication

Submit

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