Intake form

Name *

Email address *

What age group does the participant belong to?

Which sports are you interested in?

Please select at least one option.

Soccer

Basketball

Baseball

TeeBall

MulitSports Program

What type of mentorship are you seeking?

Please select at least one option.

One-on-one mentorship

Group mentorship

Sports clinics

Traveling sports teams

What are your goals for participating in the program?

Do you have any previous sports experience?

How did you hear about positive impact sports program?

What are your preferred days for sports activities?

Please select at least one option.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Additional questions or comments

Positive Impact Sports Program