Peer Mediator Re-commitment Form
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Email *
What is your grade level? *
List your elective classes only for 1st semester. I need to know when you are available for tours, peer mediation, etc. Also when is your lunch period.  *
Peer mediator duties are mostly held during the school day. Do you agree to attend all events (lunch & learns, sign up days, new student orientations, fundraisers, etc.) *
I agree to pay $20 mandatory membership fees as a returning peer mediator.
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3. I agree to keep all matters discussed with me as a peer mediator confidential unless there is disclosure of suicidal thoughts or actions, abuse, and/or hurt / harm to any individual. Then this information will be reported directly to the sponsor. *
I agree to use my peer mediator pass for official peer mediator business only. I further understand that any misuse of the pass will result in immediate dismissal from the peer mediation organization. *
I agree to attend mandatory peer mediator training. *
T-shirt Size in Adult *
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