Thank you for your request for a mentor! We’re excited to connect with you soon. Once you complete this form, our team will follow up to share more details about the program, the application process, mentor training, and next steps.

To Be Requested by Guardian

Pearl Promise collects information about your child’s identity and requests your child’s participation in surveys to enhance our services and evaluate our program. This information is securely stored and used solely within the organization.

Date picker

How did you Hear about Pearl Promise's Kids Mentoring Program?

Child / youth first name

Child / youth last name

Gender

Male

Female

Other

Age (must be between 10 - 17)

Date of Birth

Month

Day

Year

Child / Youth Cell Phone (if applicable)

Multi-line address

Country/Region

Address

City

Zip / Postal code

School

Grade

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Parent / Guardian Name(s)

Relationship to Child

Phone

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Emergency Contact (different from parent, if applicable)

Phone

Relationship to Child