29:11 Mentorship Program
  • Home
  • About
  • EVENTS
    • Night of Hope 2018 Replay
    • Parenting On Purpose
  • Spring 2019
    • Schedule
  • Contact
    • Staff
    • Meet The Mentors
    • Request For Ministry
  • Gallery
    • Meet the Mentees >
      • Meet our Leadership Team
  • Sponsors
  • 29:11 Freeze
  • Feet2Faith
  • 30 for 30
  • Leadership Trip
  • Day of Hope 2019
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Fill out the registration form online below
Then pay the Registration Fee via PayPal (All major cards accepted)
Orientation Presentation Here

    2016 Summer Camp Registration
    June 6 - July 22
    Park Forest Middle School
    3760 Aletha Dr., Baton Rouge, LA 70814
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    Please give Guardian's Contact Information According to the Previous Question's Response

    NUMBERS TO BE USED FOR "ONE CALL SYSTEM" WHICH WOULD RECEIVE VOICE, TEXT, EMAIL AND MESSAGING
    You can choose for one or both parents to receive the "One Call" messages
    You can choose for one or both parents to receive the "One Call" messages

    EMERGENCY INFORMATION AND AUTHORIZED PICK UP PERSONS OTHER THAN YOURSELF
    Relation to child of 1st emergency contact
    Relation to child of 2nd emergency contact
    Primary Number of 1st emergency contact
    Primary Number of 2nd emergency contact
    Work Number of 1st emergency contact
    Work Number of 2nd emergency contact

    PERSON WHO HAS FINANCIAL RESPONSIBILITY FOR TUITION AND OTHER SCHOOL RELATED FEES

    UNAUTHORIZED PICK UP
    HEALTH INFORMATION
    Explain other, name all medications, and also list all allergies in this box

    School must have copy of insurance card

    I understand that it is my responsibility to keep 29:11 Mentorship program aware if there are any changes to the above information. I understand that if my child is to be given prescription medication during program hours, it is my responsibility to fill out a “Parental Consent For Medication” form. 


    By submitting below, I am stating that all above information is accurate and true and I agree to the electronic communication terms within this form.
    
    Only paid applications will be granted the opportunity for enrollment in the 29:11 Mentorship Program.
    Any questions please contact Tremaine Sterling at 225-287-1344.
    


    You will be redirected to PayPal to pay the Registration Fee ($50.00), Week 1 Payment ($80) and Week 2 Payment ($80) all due at time of registration (Total $210).  

    ​Please click ADD by "Add Student's Name HERE" or "other info" (
    under the shipping address verification section) 
    and type student's name in the box.
Submit
  • Home
  • About
  • EVENTS
    • Night of Hope 2018 Replay
    • Parenting On Purpose
  • Spring 2019
    • Schedule
  • Contact
    • Staff
    • Meet The Mentors
    • Request For Ministry
  • Gallery
    • Meet the Mentees >
      • Meet our Leadership Team
  • Sponsors
  • 29:11 Freeze
  • Feet2Faith
  • 30 for 30
  • Leadership Trip
  • Day of Hope 2019