In-School Mentoring - Child Application Form Please choose your child’s school from this list, or “other” if their school not listed and share the school name.*Admiral Seymour Elementary SchoolBayview Community SchoolBrooksbank Elementary SchoolCaptain James Cook Elementary SchoolCentral Elementary SchoolClayton Elementary SchoolEdmonds Elementary SchoolHastings Elementary SchoolJohn Henderson Elementary SchoolL'École Bilingue Elementary SchoolMaywood Community SchoolMiller Park Community SchoolKB Woodward Elementary SchoolMartha Currie Elementary SchoolNewton Elementary SchoolRidgeway Elementary SchoolSir Sandford Fleming Elementary SchoolStoney Creek Community SchoolQueen Elizabeth Elementary SchoolWalter Moberly Elementary SchoolWE Kinvig Elementary SchoolOtherOther Student Name* First Last Birthdate* MM slash DD slash YYYY Gender identity of the child* Parent/Guardian's full name* Relationship to the child?* Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Email Address* Enter Email Confirm Email Home Phone*Cell Phone*OPTIONAL - Work PhoneEmergency ContactPlease ensure this person is someone other than the parent/guardian, and they must have a phone number that is different from the parent/guardian.Emergency Contact's Full Name* Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Relationship to Child* Home Phone*Cell Phone*What school is your child enrolled in?* What grade is your child currently in?*Please list at least four of your child's interests and favourite activities to help us match your child to a Mentor who shares similar interests.*Where did you hear about the program?*The following optional information is asked for statistical purposes and for grant/funding support. The questions and responses do not indicate or affect participation requirements.OPTIONAL - What ethnicity is your child? OPTIONAL - Was your child born in Canada? If not, how long as your child lived in Canada? Languages Spoken Is there anything else you would like to share with us or that may be important for us to know?
