Parent Inquiry Parent Inquiry Parent Inquiry PRIMARY CAREGIVER (PARENT / LEGAL GUARDIAN) * First Name Last Name Relationship to Child * Email * Phone * Country (###) ### #### CHILD INFORMATION * First Name Last Name Date of Birth * MM DD YYYY Gender * Male Female Which school do they attend? * Grade Level / Year * Address of primary residence * Address 1 Address 2 City State/Province Zip/Postal Code Country How did you hear about one2one Cayman? * School Another parent / guardian Social media Service provider referral Word of mouth Other Reason for interest in enrolling child in one2one Cayman: * If the child is diagnosed with a medical / developmental disability, please describe below: Please list any anticipated barriers or challenges that the child may have while spending time with a mentor: * Please list any challenges that the primary caregiver may have in providing support to the child or mentor: * Are there any 3rd party service providers in relation to this child? (DCFS, Therapist, Care Order, etc.) * Yes No If yes, please provide more information: Acknowledgements * Please note that completion of this inquiry form is not equivalent to the completion of an application, and as such submission of this form does not guarantee entry into the program. Upon receipt of this inquiry form, one2one Cayman will review the content and should the child meet the basic program criteria, the Parent/Guardian will be contacted and invited to complete a Youth Application Form in order to proceed with the enrolment process. I understand. Thank you for submitting a Parent Inquiry form. A member of our team will be in touch soon. Please contact us should you have any questions.
