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DREAM Online Registration

There is no cost for registration, but you must be willing to commit to our program for at least one year. Monthly meetings with students will be communicated at the day camp for 2007-2008. 

Dallas, TX residents:

Call Mocha Sisters Organization at (877) 877-512-0771 to leave a message for Gina Harbour, DREAM Director or email us at mentoring@mochasisters.org for more information.

 

Augusta, GA residents:

Call Mocha Sisters Organization at (877) 877-512-0771 to leave a message for Daphne Ali, Augusta Branch President or email us at info@augustamochasisters.com for more information. 

We are so grateful that you are expressing an interest in having your child participate in DREAM 2007-2008.  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.

  
 
 

Register Now!!

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

Dallas/Fort Worth, TX and Augusta, GA residents only.

Child's Name 

 

Child's Grade Level

 

Address

 

City

 

State

 

Zip

 

Parent/Guardian Name

 

Home Phone Number

 

Preferred Email Address

 

Emergency Contact

 

Emergency Number

 

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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