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Oasis Mentoring Program Enrollment Form (2018-19)
(To be completed by the Parent/Guardian)
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* Indicates required question
Email
*
Your email
PERSONAL INFORMATION
*
NEW ENROLLMENT
RE-ENROLL
YOUTH'S NAME:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
AGE:
*
Your answer
GENDER:
*
FEMALE
MALE
ETHNICITY:
AMERICAN INDIAN or ALASKA NATIVE
ASIAN
BLACK or AFRICAN AMERICAN
HISPANIC or LATINO
NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER
WHITE
HAITIAN
NAME OF SCHOOL:
*
Your answer
GRADE:
*
KINDERGARTEN
1ST GRADE
2ND GRADE
3RD GRADE
4TH GRADE
5TH GRADE
6TH GRADE
7TH GRADE
8TH GRADE
9TH GRADE
10TH GRADE
11TH GRADE
12TH GRADE
T-SHIRT SIZE ($15)
*
YOUTH XS (SIZE 4-5)
YOUTH S (SIZE 6 - 7)
YOUTH M (SIZE 8 - 10)
YOUTH L (SIZE 12 - 14)
YOUTH XL (SIZE 16 - 18)
ADULT S
ADULT M
ADULT L
ADULT XL
ADULT XXL
ADULT XXXL
PARENT/GUARDIAN NAME:
Your answer
RELATIONSHIP TO YOUTH:
*
MOTHER
FATHER
Other:
STREET ADDRESS:
*
Your answer
CITY, STATE, ZIP:
*
Your answer
PRIMARY PHONE NUMBER:
*
Your answer
OTHER PHONE NUMBER:
Your answer
EMAIL:
*
Your answer
EMERGENCY CONTACT NAME:
*
Your answer
EMERGENCY CONTACT PHONE NUMBER:
*
Your answer
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