Child Mentorship Program Consent Form
Child Information
Full Name
Date of Birth
Parent/Guardian Information
Full Name
Phone Number
Email Address
Consent
I consent to my child’s participation in the Child Mentorship Program.
I have read, understood, and agree to the terms, policies, and procedures of the program.
I consent to photos/videos of my child being taken during program activities.
Emergency Contact
Contact Name
Phone Number
Medical or Special Needs
Please specify any relevant medical conditions, allergies, or special needs
Parent/Guardian Signature
Date