Youth Enrollment

Tuesday’s Children’s Youth Mentoring Program can be delivered in-person, virtually or as a combination of both. Which method do you prefer? *This question is required.

In-person but virtual if no mentors are available in-person after 60 days. *This question is required.

1. How did you hear about Tuesday's Children? *This question is required.

2. If you were referred to us by Gold Star Gamers, What games do you play?

3. What type of games do you play? (strategy, first person shooter etc.)

4. What system(s) do you play on?

5. Do you use Discord?

6. What days and time are you available to play?

Child's Information

First Name *This question is required.

Middle Name

Last Name *This question is required.

Nickname

Street Address *This question is required.

Apt/Suite

City *This question is required.

If you said other, please specify.

Zip *This question is required.

Email Address of Child This question requires a valid email address.

Primary Phone Number of Child Please provide a 10-digit phone number including area code.
Enter numbers only. Formatting such as dashes will be added as you enter your phone number.

Secondary Phone Number of Child

Date of Birth *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Gender *This question is required.

If you said other, please specify. *This question is required.

If you said other, please specify.

Name of School *This question is required.