Enrollment Inquiry

Enroll your child.
Start the next chapter.

Share a few details about your family and the program you're interested in. An intake team member will reach out to schedule a conversation. This inquiry is confidential.

Guardian Information

Guardian Name *Guardian Email *PhonePreferred Contact

Child Information

We only collect what's needed to connect. Sensitive medical, mental health, or behavioral information should not be shared on this form.

Child's First Name *Age *GradeSchool

Preferred ProgramAnything else we should know? (optional)

Guardian Acknowledgment

I am the parent or legal guardian of this child and consent to Change Center Mentoring Group contacting us about program participation. I understand that enrollment is subject to intake, availability, and program-specific requirements.(Optional) I consent to Change Center using approved photos of my child in organizational communications. This is separate from program participation and can be given or withdrawn at any time.

Your information is confidential and only used for enrollment follow-up.

Enroll your child.Start the next chapter.

Guardian Information

Child Information

Guardian Acknowledgment

Enroll your child.
Start the next chapter.