Online Enrollment for Group Sessions

Enrollment for Group Sessions

Please note this form is only for those interested in enrolling in our upcoming Sister Girlz group sessions from February 18, 2023 through November 11, 2023!

We currently accept Credit/Debit Cards and PayPal for all online enrollments. For any questions, please email Sonya at [email protected] or call 248-910-5766.

Mentee Name *

First

Middle

Last

Parent/Guardian Name *

First

Middle

Last

Mentee Date of Birth *

Mentee Age *

Mailing Address *

City *

State *

Zip Code *

Mentee Email (if applicable)

Mentee Phone Number (if applicable)

Parent Email *

Parent Phone Number *

Mentee T-Shirt Size *

What group are you registering Mentee for? *

Which session(s) are you registering Mentee for?

February 18, 2023 - April 1, 2023 - $ 200.00
April 8, 2023 - May 13, 2023 - $ 200.00
June 3, 2023 - July 15, 2023 - $ 200.00
July 22, 2023 - August 26, 2023 - $ 200.00
October 7, 2023 - November 11, 2023 - $ 200.00

How did you hear about LTAI?

If referral or other, please share

What do you hope your youth will gain from LTAI program? *

What hobbies does your youth enjoy or participate in? *

What topics would your youth like to discuss? *

Additional Comments (optional)

Total Cost

$ 0.00