Parent Authorization
NOTIFY IN CASE OF EMERGENCY
Name Relationship ___________________________________
Address ___________________________________________
City _____________________ State _______ Zip Code ______
Home Phone ________________ Work Phone _________________
PARENTAL CONSENT
I have read and understand the information given to my child about the Mentor Project. I hereby give my permission for my child _______________________________, to participate in this program. I will assist my child in keeping all appointments with his/her mentor. I will attend all parent events whenever possible and I agree to communicate with the Mentor Coordinator regarding any concerns I may have about my child’s participation in the Mentor Project. I also understand that I will be given the opportunity to meet my child’s mentor. I also understand that my child will meet with his/her mentor at supervised scheduled events held at the school or other community center. Should an event be scheduled away from the school, I am responsible for my child’s transportation.
All meetings between my child and his/her mentor held outside of the school setting, and not supervised by the mentor project staff, shall be arranged by me, my child, and the mentor, and I take full responsibility for such meetings.
Date Signature of Parent/Guardian