Mentoring Programs | Brooklyn, NY

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Level One: 13 to 17

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Agree to being photographed or videoed

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I am responsible for making sure my child/mentee/student(s) reach home safely. No person working with Herunivercity Inc. is responsible for any transportation.

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Level Two: 18 and Above

Full Name

Email

Phone Number

Emergency Contact

Do you have allergies?

No

Yes

If yes please specify

Do you take medication?

No

Yes

If yes please specify

Do you have any medical conditions?

No

Yes

If yes please specify

Price

Comments

Agree to being photographed or videoed

Check box if you agree with below agreements:

I am responsible for making sure my child/mentee/student(s) reach home safely. No person working with Herunivercity Inc. is responsible for any transportation.

Thank you!

We have received your submission.

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Bad respond

Herunivercity Inc.

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P.O. Box 22274, Brooklyn, NY 11202

Phone: (929) 373-7130 | Copyright ©. Herunivercity Inc. All rights reserved.

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