JBBBSLA Youth Inquiry Form

The child/ren I wish to enroll identify as Jewish

YesNo

The child/ren I wish to enroll are between the ages of 6-17 years old

YesNo

Thanks for your interest in our Youth Mentoring Program! Please complete and submit the following inquiry form and a member of the enrollment team will get back to you with next steps in the next few days.

Non-Discrimination Policy

Our participants come to us with a wide range of personal characteristics. Participant eligibility shall be determined without regard to race, color, national origin, gender, marital status, sexual orientation, gender identity, veteran status, or disability.

Youth Information

Enrollment Record ID

Contact Record ID

PG Contact Record ID

First Name

Last Name

Preferred First Name

Birthdate

Gender

How does the youth identify?

Personal Pronouns

What pronouns does the youth use?

I'd like to enroll another child:

YesNo

2nd Youth Information

First Name

Last Name

Preferred First Name

Birthdate

Gender

How does the youth identify?

Personal Pronouns

What pronouns does the youth use?

Parent/Guardian (P/G) Information

P/G First Name

P/G Last Name

P/G's Relationship to Youth

Phone

Personal Email

How did you hear about Jewish Big Brothers Big Sisters of LA?

Please list the specific NAME related to your answer above (e.g., name of synagogue, Big or website, etc.)

Concatenated Referral Type and Source

Please tell us briefly why you would like a mentor for your child:

Youth Residential Address

Street Address

(please include apartment or unit #)

City

State

Zip Code

Zip Code's Agency Location

Other Agency Opportunities

Our one-to-one mentoring program requires that children be 6-17 years old, identify as Jewish, and living in Los Angeles. If you are interested in a non-denominational one-to-one mentoring program, please contact Big Brothers Big Sisters of Greater LA at (213) 481-3611 or via bbbsla.org, or Catholic Big Brothers Big Sisters (which accepts all faiths) at (213) 251-9800 or via catholicbigbrothers.org.

We are sorry, but our one-to-one mentoring program requires that children be 6-17 years old.

Contact Information