100% Club Registration Form

(* Denotes Required Fields)

Step 1: Your Information
First Name: *
Last Name: *
Email Address: *
Primary Phone: *
Street Address: *
City: *
State (e.g. GA): *
Zip Code:
How did you learn about Horizons Atlanta?: *
Step 2: Sponsorship Preferences
Is there a specific student you would like to sponsor? If so, provide as much information about that child as possible and Horizons Atlanta will contact you about the match.:
If not, please select a student from our featured profiles or answer the following questions and we will match you a student who fits that description.:
Do you have a preference as to a male or female student?:
In what grade would you like for the student to be enrolled?:
Do you have a preference for which program you would like your sponsorship to support?:
Step 3: Donation
Please indicate your method of payment. Online payments will be processed immediately via our DonorBox site: *