K-5 After School Mentoring Registration
Dates and Times: 4/23/19-5/23/19 from 3:00-5:00pm (Spring) and 9/9/19-12/19/19 3:00-4:00pm (Fall)
Address: 927 3rd St, Rosenberg TX 77471
Male or Female
Grade in school
Cell Phone Number
Emergency Contact Info
Name of Local Friend or Relative
Relationship to Student
By signing below, I give my permission to Fort Bend Hope to use either photographs or video recordings for publication and/or public relations efforts, such as newsletters, brochures, newspaper articles, website, displays, films, etc., both physical and virtual in format.
I hereby give permission for my child (above referenced) to participate in Fort Bend Hope’s After School Mentoring Program. I agree to return any books and/or materials to Fort Bend Hope that my child checks out to bring home. I agree and accept that in the event of any accident or injury involving my child, myself, or my designated adult, I will not hold employees or volunteers of Fort Bend Hope from personal injury or other claim.
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