Fixed Term Mentor Enquiry Form

Parent's Name *

First

Last

Parent's Contact Telephone Number *

Parent's Email *

Daughter's Name *

First

Last

Which district do you live in? *

Please select the district you live in from the drop down menu

For your daughter

I am able to commit to attending a 2hr Butterflies session once each month for 11 months.
I feel comfortable sharing my experiences within a group.
I enjoy participating in fun group activities.

Please select if the answer is yes.

Why would you like to become a Butterflies Fixed Term Mentor? *

Please give a brief explanation of why you would like to join the Butterflies Programme and become a Mentor.