Complete a mentee referral form - YMCA of Silicon Valley - ymcasv 2026

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The document is a referral form for the Reach & Rise™ youth mentoring program by the YMCA of Silicon Valley. It collects detailed information about the child, their family, and the reasons for referral, including personal details, living situation, and specific challenges faced by the child. Additionally, it includes a release and waiver of liability agreement for participants in YMCA programs.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Child Information' section. Enter the child's name, gender, age, and address. Ensure you provide accurate contact details for both the child and parent/guardian.
In the 'Referral Information' section, include the name of the person making the referral along with their contact information. Specify how they prefer to be contacted.
Complete the 'Family Information' section by detailing living arrangements and yearly household income. This helps in understanding the child's background better.
For 'Reason(s) for Referral', check all applicable boxes and provide a detailed description of any specific challenges or goals for the child.
Finally, review all sections for accuracy before submitting your completed form through our platform.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (65 Votes)
2017	4.9 Satisfied (39 Votes)

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What do the YMCA do?

Local YMCAs deliver projects and services focused on youth development through a wide variety of youth activities, including providing athletic facilities, holding classes for a wide variety of skills, promoting Christianity, and humanitarian work.

How do I cancel my YMCA membership in Silicon Valley?

You can cancel your YMCA membership within your ymcasv.org online account. If you wish to cancel your Y membership, visit your YMap account.

What did the YMCA stand for?

The YMCA stands for Young Mens Christian Association. Modern Day YMCAs are simply referred to as The Y. Originally the YMCA was a Christian based organization eventually accepting all religions and races.

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