I understand that the West Hartford Public Schools Mentor Program involves spending approximately up to one hour each week from September to June at an assigned school with my mentee. I will be committing to one school year in the program and will then be asked to renew for another year. I have not been convicted, within the past ten years, of any felony or misdemeanor classified as an offense against a person or family, of public indecency, or a violation involving a state or federally controlled substance. I am not under current indictment. Further, I hereby fully discharge the school personnel, participating companies, or organizations from any liability, claims, causes of action, costs and expenses which may be attributable to my participation in the West Hartford Public Schools Mentoring program. I understand that the West Hartford Public Schools Mentor Program and relationships established take place during the confines of the school day in West Hartford, CT. It is not part of any relationship established between mentor/mentee and family members beyond the school day. I also understand that any photographs and/or video taken during the mentoring sessions become the property of WHPS and may be included in promotional materials. I have read the above release statement and agree to its content. To the best of my knowledge and belief, all statements in the application are true. *Please indicate your acceptance of this statement by providing your name and date in the space below. *