Sponsorship opportunities are available. Please contact us at sponsorship@mochasisters.org or
call us at 877-512-0771 (voicemail/fax)

 

 

 

 

 

 

DREAM Online Registration

Cost of registration will be based on funding. Once you register you, you must be willing to commit to our program. Meetings with students will be communicated at the DREAM kickoff for 2010.

Augusta, GA and surrounding cities residents:

info@mochasistersaugusta.org

 

Dallas, TX and surrounding cities residents:

mentoring@mochasistersdallas.org

 

Frisco, TX and surrounding cities residents:

mentoring@mochasistersfriscotx.org

 

Houston, TX and surrounding cities residents:

info@mochasistershouston.org

 

New York City, NY and surrounding cities residents:

MSOnyc@mochasisters.com

We are so grateful that you are expressing an interest in having your child participate in DREAM 2010.  Please take a few moments to fill out the form below.

Please read our Notice Agreement and Participant Release and Indemnity Agreement before submitting your child's online registration form.

Once we receive your information, we will enter it into our program database and inform the relevant youth coordinators program in your area.

 
 
 

Register Now!!

Please note:  One Registration form must be completed for each child.

Child's Name 

 

Child's Grade Level

 

Address

 

City

 

State

 

Zip

 

Parent/Guardian Name

 

Home Phone Number

 

Preferred Email Address

 

Emergency Contact

 

Emergency Number

 

Indicate Branch Affiliation child?

Augusta, GA

Chicago, IL
Dallas, TX

Frisco, TX

Houston, TX

New York City, NY

 

Where do you prefer to be contacted?

Home Address/Phone
Business Address/Phone


Allergies:


 


Special Comments:


 

 

 

Please, choose Four Sessions for Child.

Job Interview Techniques
DREAM new ideas
Home Training and Manners
Learning to Respect Yourself and Others
Saying No to Drugs
Health & Exercising

Consequences of Your Behavior

African-American Heritage

Dating Awareness

Arts & Crafts

Parent/Guardian Electronic Signature:

I have read and agree to both the Notice Agreement and Participant Release and Indemnity Agreements.

 

 

 

 
 
 
   

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