Distance Mentoring Permission Form

Just because we can’t mentor at the Club doesn’t mean mentoring has to stop! Complete the form below so your child can be a part of the Club’s mentoring program during these stressful times.

OJJDP Parent/Guardian Consent Form

Guardian/parent consent for member to participate in OJJDP Mentoring program

  • PARENT/GUARDIAN CONSENT FORM


    I hereby give my permission for my child to participate in the Mentoring Program at the Boys & Girls Club.


    I fully understand that the program involves mentors, who shall be selected from the community and will be screened (including a criminal background check) and trained before beginning in the program. A mentor will be expected to spend a minimum of one hour per week with my child on-site at the Boys & Girls Club. The mentor is not allowed to take or meet my child beyond the Club facility.


    I understand that my child will participate in an orientation session at the Club in which the program will be explained. The program is planned to last one year and continuation may then be discussed.


    I understand that during the course of the mentoring program there may be special group events (incorporating all mentors and youth) and family events planned. I understand that the staff of the Club will provide ongoing monitoring of the mentoring activities.


    I give the Boys & Girls Club Mentoring Program Coordinator permission to obtain my child's academic and attendance records from my child's school.


    I permit the Mentoring Program staff and the Boys & Girls Club to utilize photographs of my child taken during his/her involvement in the mentoring program and waive all rights of compensation.

Spanish Version