Resonant Vibe Youth Mentoring Inquiry Form

Welcome!

Thank you for your interest in enrolling your child into our R.I.S.E. Youth Mentoring program!

Please note that this is not an application. We will contact you to fill out a full application soon.

Questions? Contact Katie: katie@resonantvibe.org or call 574-830-5013.

Youth Information

Youth Legal First Name

Youth Name Used (if different from legal name)

Youth Last Name

Youth Date of Birth (mm/dd/yyyy)

Age (Child must be at least 6 years old)

Youth Gender:

Self Described Gender:

Is your child part of the LGBTQ+ Community?

YesNo

Program Enrollment Name

Parent/Caregiver Information

Legal First Name

Name Used (if different from legal name)

Last Name

Date of Birth (mm/dd/yyyy)

Contact Information

Parent/Caregiver Email address

Parent/Caregiver Phone Number

Mailing Address

Street Address:

Apt #:

City:

State

Zip Code

County

ElkhartSt. Joseph

What are you interested in?

Check all that apply:

Mentoring for your childCommunity Events: Connect with community events, educational events, fun family eventsJoining Parent Advisory CouncilJoining Resonant Vibe's Board of Directors

How did you hear about us?

Check all that apply:

GoogleFacebookInstagramFriend/FamilyBoard MemberResonant Vibe StaffOther

Please share where you heard about our organization!

I heard about Resonant Vibe through:

Contact Information