The 12-Day Teen Mentorship Challenge Form

Teen 12-Day Mentorship Challenge Registration Form.

Teen Information

Full Name of Teen:

Date of Birth (DD/MM/YYYY):

Gender:

Male
Female

Challenge Information Date

Current School Grade / Class:

Parent/Guardian Information

Full Name of Parent/Guardian:

Relationship to Teen:

Parent's/Guardian's Email Address

Location (Town/City & Country):

Select Your Access Tier

Core Crew – KES 5,000 / $39 Includes challenge access, daily devotional guides, activity worksheets, and a certificate of completion.
Growth Cycle – KES 10,000 / $77 Includes Trailblazer benefits plus live Zoom mentorship, Q&A sessions, accountability check-ins, and a printable challenge journal.
Next Level Nation – KES 20,000 / $157 Includes Game Changer benefits plus a 1:1 personalized mentorship call, lifetime access to challenge recordings, a digital badge, and entry to the Yearlong Mentorship Circle.

Choose Your Challenge Month

April
August
December

How did you hear about us?

Consent & Commitment

Yes, I agree

I, the parent/guardian, confirm that the information above is accurate and that I consent for my teen to participate in the 12-Day Mentorship Challenge. I understand the program includes Christian content, online sessions, and community interaction.

Phone Number (WhatsApp preferred):