C.H.A.M.P. Inc. Consent to Share Information
Email *
Consent to Share/Match Information

I have documented and confirm the information about my child, which may be shared with a potential match mate (prepared by Community Hands in Action Mentoring Program Inc.), and consent to its disclosure to a potential match mate (for me), (for my son or daughter). I understand the (I) (my son or daughter) will not be identified by name until after the match has been agreed upon. It is also my understanding that the potential mentor could have a criminal history. All mentor will be vetted for crimes against child(ren) through criminal background check and child protection services, DCF. I give permission for such matching information to be shared with a potential match mate only under the above conditions. This consent expires one year from the date indicated below, or at the time a match is formalized, whichever occurs first.
Parent: I consent to the statement above. *
Parent Consent
I agree to adhere to the values mentioned above *
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