Thank you for 13 incredible years! We have closed our doors, but we invite you to join us for our closing ceremony May 14, 2026!

Enrollment Form G.O.A.L.S. Mentorship Program

First name*

Last name*

Birthday*

Month

Day

Year

Address*

Email*

Is this your first time in our program?*

Yes

No

Phone*

Parents Full Name and Number*

List Any Allergies and Medications Needed While Attending The Program*

Shirt Size*

Small

Medium

Large

X-Large

Will The Mentee Be Catching Septa or Uber From The Program?*

Yes

No

Full Names and Numbers of other Designated Adults for Pickup*

Parent Signature*

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

bottom of page