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“Mentee” Application
Date: _______________
Student’s Name: __________________________________ Age: _______
Parent/ Guardian’s Name: ______________________________________
Address: _____________________________________________________ ____________________________________________________________
Home Phone: _______________________ Work Phone: __________________
Parent E-mail:__________________________ Student E-mail: __________________
Is there any information you would like us to know about your child? Likes/ Dislikes?
__________________________________________________________________________________________________________________________________________ _____________________________________________________________________
Mentors Matter Agreement/ Permission Form
I give my child, _________________________________, permission to participate fully in Mentors Matter mentoring program. 1. I will help to have my child keep his/her scheduled times with their mentor. 2. I will be informed by the mentor as to when my child will meet with his/her mentor and what they plan to do. 3. I give permission for my child to travel with their mentor and the Mentors Matter Director in their vehicle. 4. I understand that my child will also be required to participate in monthly Community Outreach outings to The Parkesburg Point, The Harrison House in Christiana, PA to spend time with the elderly and/or other opportunities and hereby give my permission for him/her to do so. 5. I understand that there will be planned family events for family, child and mentor to meet and interact and I agree to be in attendance, to the best of my ability.
Parent or Guardian Signature____________________________________
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