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Mentoring Program: Application

The document is an application for a mentoring program run by Fitness and Mentoring. The application requests information about the applicant, including name, contact details, and emergency contacts. It also requires the parent/guardian's signature granting permission for the applicant's participation, transportation in case of emergency, and use of photographs. The applicant and parent must each attach a paragraph explaining what they hope to gain from the program by listing interests and hobbies. Signing the form indicates understanding that disruptive behavior could result in dismissal from the program, and that the organization is not liable for injuries or lost items. Applicants will be notified within 7 days if accepted.

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Batisha Branner
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24 views3 pages

Mentoring Program: Application

The document is an application for a mentoring program run by Fitness and Mentoring. The application requests information about the applicant, including name, contact details, and emergency contacts. It also requires the parent/guardian's signature granting permission for the applicant's participation, transportation in case of emergency, and use of photographs. The applicant and parent must each attach a paragraph explaining what they hope to gain from the program by listing interests and hobbies. Signing the form indicates understanding that disruptive behavior could result in dismissal from the program, and that the organization is not liable for injuries or lost items. Applicants will be notified within 7 days if accepted.

Uploaded by

Batisha Branner
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Mentoring Program

APPLICATION
*All information on this form is confidential and used solely by Fitness and
Mentoring

Date of Application _______

Mentoring Program.

I.

APPLICANT

Name _____________________________________ Date of Birth _________


Address_______________________________________________________
Home ( )___________________

Mobile (

)________________________

Email________________________ School/Grade_______________________

II.

PARENT/GUARDIAN

Parent/Guardian _________________________________________________
Home (___) ___________________ Mobile (___) _______________________

Email__________________________________________________________

III. EMERGENCY CONTACT


Emergency Name ________________________________________________
Relationship to Applicant ___________________________________________
Home (___) ___________________ Mobile (___) _______________________
In the event of an emergency, SPARKLE volunteers and staff have my permission
to transport or allow emergency personnel to transport my child to the nearest
hospital.
__________________________________

_______________________

Parent/Guardian Signature

Date

IV.

MEDIA RELEASE

I understand that during this program, my childs photograph may be taken and I
give permission for the photograph or video to be used for any promotional or
media coverage.
___________________________________

_______________________

Parent Signature

Date

V.

ESSAY (APPLICANT AND PARENT)

Please attach a paragraph explaining what you hope to gain from Fitness and
Mentoring Program. Please include your interests and hobbies.

VI.

DISMISSAL

I give my child permission to participate in Fitness and Mentoring Program. I


understand that SPARKLE has the right to withdraw any applicant from the
program in the event she displays harmful or disruptive behavior towards other
applicants, volunteers, or staff. I understand that SPARKLE will not be held liable
for any personal injury or lost or stolen property.

___________________________________

_______________________

Applicant Signature

Date

___________________________________
Parent Signature

_______________________
Date

Applicants and parents will be notified via phone or email within 7 days of
their acceptance into the program.

501(c)3 non-profit organization

www.fitnessandmentoring.com

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