I would like my child to participate in the MENtors program. I understand that all MENtors are volunteers, and that all mentoring activities are intended to assist you with core values such as respect, academic responsibilty, health & wellness and social/emotional wellness. *

I grant permission for myself to be photographed, recorded for MENtors promotional and educational materials. I understand said photo, speech, or video may appear in various publications or marketing and media outlets for recruitment of volunteers. I understand any form of media can be used on social media platforms or the website (www.cincymentors.org). *

I understand that deviations from MENtors guidelines, can lead to my child's removal. *

Participant/Child Name (Ex. LeBron James) *

Race *

Participant Date of Birth *

School *

Shirt Size *

Guardian Name *

Guardian Phone *