Peer Mediator Re-commitment Form
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Student's Name *
Email address (Very important to use an up-to-date email. This will be the main way we communicate.) *
1. 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.) *
2. 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. *
4. 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. *
5. I agree to attend mandatory peer mediator training. *
6. T-shirt Size in Adult *
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