OT Sign Up Only

Operation Timothy Sign Up Only

Step 1 – Fill Out the Form

Registration is $25. (Does not include a uniform).
Registration plus a uniform is $50.
Step 1 – Fill out the form.
Step 2 – Pay at the bottom of the page.

Name of Mentee:
Age of Mentee:
Mentee Cell Number:
Mentee Email:
Mentee Birthday:
Mentee School Name:
Mentee Grade:
Mentee Graduation Date:

PARENT / GUARDIAN INFORMATION

Father's / Guardian Name:
Father's Cell Number:
Father's Email:
Father's Address:
Mother's / Guardian Name:
Mother's Cell Number:
Mother's Email:
Mother's Address:

SECONDARY CONTACTS

Emergency Contact Name:
Emergency Contact Phone:

MEDICAL HISTORY

Does your child have any food allergies?:

HANDBOOK

I have read and agreed to the terms of the Operation Timothy - Rites of Passage Handbook. I understand the behavior that is required of my child.:
YesNo

Mentee Hobbies/Sports

Student's Sports (Check all that apply):
BasketballBaseballFootballTrack & FieldSoccerLacross

Describe your child leadership skills and abilities:
Please tell us about your child strengths and weaknesses:
Does your child have any medical or physical challenges that require assistance?:
Goals you would like to see achieved through this mentoring program:
Briefly tell us why you have chosen to this mentoring program for your child:
Complete Step 1 – Click the ‘Send’ button below to send the form info.

Step 2 - Pay Registration Fee

Make sure to complete STEP 1 above so that we have the information. Next, complete step 2 below.

Step 2 – Pay Registration Fee (Without the uniform) - $25

— OR —

Step 2 – Pay Registration Fee Plus Uniform - $50