Youth Mentorship Program Consent Slip

Participant Information

Participant Full Name Date of Birth Parent/Guardian Name Contact Number

Program Details

Program Name Program Dates

Consent and Acknowledgment

I hereby give permission for my child to participate in the above nonprofit Youth Mentorship Program. I acknowledge that I have been informed about the nature of the activities and consent to the participation of my child. I agree to adhere to the rules and guidelines set by the organization.