Academy 4 - Mentor Sign Up

Legal First Name

Legal Last Name

Preferred First Name - This will be the name printed on your name tag

Employer Name

Phone Number

Phone Type

Second Phone Number

Phone Type

Email Address

Address 1

Country

City

State

Zip/Postal Code

Target School

Do you speak Spanish?
Yes No

Birthdate- MM/DD/YYYY

Gender
Male Female

To best match students to mentors, please select your activity level
Active (likes to play outside) Less Active (prefers inside games or crafts)

Are you a high school student?
Yes No

How did you hear about us?

By clicking submit, you understand that Academy 4 is not obligated to provide a reason for their decision to accept or reject you as a volunteer. You also agree to provide all required background checks, child safety training and attend an orientation before becoming a volunteer.

During the program we take photos and/or videos of volunteers at placements and other activities. These may be used to promote Academy 4, including on our website, social media or in printed materials, and will not be used for any other purpose. Do you give Academy 4 permission to take, store and use your image as described?
Yes No

Academy 4 sends a monthly devotion. Would you like to receive that devotion?
Yes No

By clicking submit, you understand that Academy 4 is not obligated to provide a reason for their decision to accept or reject you as a volunteer. You also agree to provide all required background checks, child safety training and attend an orientation before becoming a volunteer.

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Corporate Office:

Email:

1905 West Broadway

info@academy4.org

Fort Worth, TX 76102

(817)-744-8707

MENTOR/VOLUNTEERREGISTRATION