Child Application

Saratoga Mentoring Program
368 Broadway—Suite 16
Saratoga Springs, New York 12866
info@saratogamentoring.org
518-581-1487

Today's Date:
Name of Child:
Date of Birth :
Ethnic Affliation/Race:
Name of Parent:
Address:
Home Phone:
Work Phone:
Cell Phone:
Email:
Name of School Child attends:
Current Grade level: