Mentoring Registration - NAOMI Kids

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Home
About Us
HEIP
Kids Program Registration
Donations
Events
Contact
- Volunteers
- Vendor Registration

Mentoring

The primary purpose of our free weekend mentoring program for children ages 4 to 11 is to provide safe, structured, and accessible positive youth development during out-of-school hours.

Register Now! Spots are limited.

Personal & Social Development

Building Social Skills: Helping children interact with peers and positive adult role models in a cooperative environment.
Emotional Support: Boosting self-esteem, resilience, and confidence through encouragement and mentorship.
Character Building: Teaching core values like teamwork, empathy, respect, and responsibility through group activities.

Community & Family Support

Removing Financial Barriers: Ensuring that all families, regardless of income, can access high-quality youth development by offering the program completely free of charge.
Safe Weekend Environment: Giving parents peace of mind by providing a secure, supervised space for their children on Saturdays.
Community Connection: Linking young families to local resources, volunteers, and support networks.

Skill-Building & Learning

Supplemental Education: Sneaking in fun, interactive learning to combat the “weekend slide” without the pressure of a traditional classroom.
Life Skills: Introducing basic problem-solving, emotional regulation, and communication strategies tailored to early childhood and pre-teen development.

1. Parent/Guardian Information

Parent's First Name

Parent's Last Name

Relationship to Child

Mother Father Grandparent Legal Guardian

Phone Number

Email Address

Home Address

City

Zip Code

2. Child's Information

Child's First Name

Child's Last Name

Date of Birth

Gender

Male Female Prefer not to say

Does your child have any known allergies?

Food Medication Seasonal Environmental None

Does your child have any medical conditions, dietary restrictions, or take any medication we should be aware of?

Medical Condition Medication Dietary Restrictions None

Are there any learning differences, behavioral notes, or special needs that will help our mentors better support your child?

Learning Differences Behavioral Notes Special Needs None

Child's First Name

Child's Last Name

Date of Birth

Gender

Male Female Prefer not to say

Does your child have any known allergies?

Food Medication Seasonal Environmental None

Does your child have any medical conditions, dietary restrictions, or take any medication we should be aware of?

Medical Condition Medication Dietary Restrictions None

Are there any learning differences, behavioral notes, or special needs that will help our mentors better support your child?

Learning Differences Behavioral Notes Special Needs None

Child's First Name

Child's Last Name

Date of Birth

Gender

Male Female Prefer not to say

Does your child have any known allergies?

Food Medication Seasonal Environmental None

Does your child have any medical conditions, dietary restrictions, or take any medication we should be aware of?

Medical Condition Medication Dietary Restrictions None

Are there any learning differences, behavioral notes, or special needs that will help our mentors better support your child?

Learning Differences Behavioral Notes Special Needs None

3. Emergency Contact

Emergency Contact

Emergency number

Relationship to Child

4. Authorized Pick-Up List

Names and Phone Numbers

Additional Info

5. Please read and check the boxes below to confirm your agreement

All the above information is correct.

Attendance Policy: I understand that this program is completely free, and spaces are limited. I agree to ensure my child attends consistently or notify the program coordinator at least 24 hours in advance if they will be absent.

Media & Photo Release: I grant permission for the program organizers to take photos or videos of my child during Saturday sessions for use in promotional materials, social media, and newsletters.

Liability Release: I give permission for my child to participate in the Saturday Mentoring Program. I release the program organizers, mentors, and venue providers from any liability for injuries or accidents that may occur during program hours.