Boys Of Hope Parent Consent & Permission Form 2020-2021

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Complete this form in its entirety.

Name of Student(s) Participating in the Boys Of Hope Program *

Permission and consent for your son/dependent to participate in the Boys Of Hope Program. (State your name) *

Parent(s) Name: *

Address: *

Home Phone: *

Cell Phone: *

Email: *

Are you on Facebook? If so, what is your Facebook name? *

Would you consider volunteering as a mentor in the Boys Of Hope Program? *

Yes

Permission for Covid-19 Testing: My son/dependent has permission to be administered Covid-19 testing at locations approved by the Boys Of Hope Program and Minnesota state guidelines, in order to participate in all Boys Of Hope sponsored events and activities, during their time in the program. (Parental Signature & Initials Required Below) *

Permission for Trips: My son/dependent has permission to travel to, attend and participate in any and all Boys Of Hope sponsored activities that are less than four hours' drive from the meeting location, two nights or less, and not considered high-risk activities as outlined by Boys Of Hope. I understand lead mentors will follow Boys Of HopeProgram standards and Activity Safety Checkpoint ... *

Yes

Required

Permission for Use of Photos: I hereby consent that the videotapes, photographs, motion pictures, electronic images, and/or audio recordings of my son/dependent may be used by Boys Of Hope for public relations and publicity purposes to include but not limited to newspapers, printed materials, website, and social media. I understand that his last name and residence will not be used for publicity purposes by Boys Of Hope without prior parental consent. *

Yes

Authorize Release of Information: I, undersigned, authorize the release of school data (academic and behavioral) to the Boys Of Hope TM Program for my NAMED BELOW STUDENT(S). The data will be used to mentor students to improve their grades, improve academic engagement, improve behavior, improved graduation rates, and prepare for college entrance. *

Yes

Required

Permission for Emergency Medical Treatment: In the event of an emergency, every effort will be made to contact a parent/guardian or emergency contact. If no contact can be made, I hereby give authorization to Boys Of Hope to seek treatment for my child and/or dependent minor by a licensed physician pursuant to Minnesota law. I know of no reason(s) why my son/dependent may not participate in prescribed activities except as noted on the Health History Form. If permission for emergency medical treatment is not given, please prepare a signed statement providing the reason, a release of liability, and alternate instructions, and email to giavolunteers@jcama.com. *

Yes

Emergency Contact #1 (Name, Phone Number, Relation to Child): *

Emergency Contact #2 (Name, Phone Number, Relation to Child): *

Parent Agreement: I have read and understand this annual permission and consent form. I may change or revoke any aspect of this agreement at any time by submitting my request, in writing, to the Boys Of Hope main office staff. 600 18th Ave N. Minneapolis, MN 55411 E-Signature(s) & Date: *

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