Refer a child to be mentored

Child's Name *
Child's Name
Date of Birth of Child *
Date of Birth of Child
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Phone *
Parent/Guardian Phone
Parent/Guardian Home Address *
Parent/Guardian Home Address

Please Note:  We are currently not accepting referrals for Anoka County.  We are hard at work trying to serve the kids on our wait list.  Please check back soon!
Referrals are OPEN for Ramsey Counties & Hennepin County.