CLICKS Parent/Guardian Information and Consent Form

General Information - This form must be submitted in order for your child/children to participate in the CLICKS Mentoring Program (an asterisk indicates a required field).

Student's First Name *This question is required.

Student's Last Name *This question is required.

Relationship to Student *This question is required.

Contact Information

Your First Name *This question is required.

Middle Name

Your Last Name *This question is required.

Suffix

Your Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip *This question is required.

Email Address *This question is required. Correspondence will be sent to this email address, so please check it regularly. This question requires a valid email address.

Home Phone

Mobile Phone

Best phone number to contact you *This question is required.

Demographic Information