Thank you for taking the time to complete our short form. The information you share with us will help our team to get a better sense of your child’s current interests, strengths, and needs so we can find the most suitable Mentor.

Please Enter your information below

Your name*
Address*
Child's Name*
MM slash DD slash YYYY
Please select the program you and your child are most interested in at this time*
If your child is interested in a second or third program then please write that in the comment section below.
What is the existing parenting arrangement?*

Have there been any changes to custody since your initial application?*
Are you or your child involved with any other agency or seeking professional support? Is your child receiving any support at their school? (i.e Social Worker, Counsellor, Therapist, IEP etc.)*
Are you anticipating any changes in your life over the next year that would impact a match for your child? i.e martial status, living arrangements, etc.*
Has your child been identified with any special emotional, social or physical needs since your original application? (i.e. learning disabilities, ADHD, behavioural/peer difficulties, etc.)*
This field is for validation purposes and should be left unchanged.