Please Return with Mentee Application
Fighting To Be Heard Youth Mentor Program
PARENT/GUARDIAN CONSENT AND LIABILITY RELEASE FORM
I give my consent for the Youth Mentor Program at the Destined for Greatness Outreach Youth Center, Inc. to match my child with a mentor apart of the organization. I will also give consent for my child to participate in all Youth Mentor Program activities; including all organized activities and transportation. In consideration of the advantages of participation in the Youth Mentor Program, the undersigned agrees that the DFGOYC Mentors, its agents, and its employees shall be released and exempt from any liability for damages for bodily injuries or property damages that may occur as a result of participation in the Youth Mentor Program, except to the extent of insurance liability as provided by law.
Print Name (Consent Signature)*full name (first, middle, last)5
Relationship to Child*7
Email*a valid email address8
Home Phone*(123) 456-789010
Address*city, state zip code11
Mobile Phone*(123) 456-789012
Language Spoken by Parent/Guardian*13
Work Phone*(123) 456-789014
Emergency Contact*full name15
Emergency Contact Phone(s)*(123) 456-789016
Will you be able to help with transportation of your child to meet with the mentor?*18 On a scale of 1 to 5 (1 being the least and 5 being the most) how involved will you be in this program?*select one19
Please write here why you think your child would benefit from the program and list anything of interest, i.e. special needs or concerns:*20
Important Information for Becoming a Mentee
What is the purpose of the program?
The Youth Mentor Program is designed to give your child an opportunity to have a one-on-one relationship with a DFGOYC student. Through these relationships, as well as recreational and group activities, mentors provide friendship, support, and guidance to your child. The mentors are there to act as a positive role model and confidant.
Can my child be tutored by his or her mentor?
The DFGOYC Youth Mentor Program is not a tutoring program. While sometimes pairs decide together to work on school work, this is not a requirement for the mentors. There are many other programs that focus on tutoring if you feel that your child needs academic support. The Youth Mentor Program focuses on fostering lasting and meaningful relationships between the mentor and mentee rather than concentrating just on academics.
What about transportation?
It is the responsibility of each mentor-mentee pair to decide on a transportation plan that will work for them. Please be aware that most mentors in the Youth Mentor Program do not have cars. If the mentor does have a car and is willing to drive your child, you will need to fill out a waiver form. If the mentor does not have a car and you cannot help with the transportation of your child, we often recommend that the mentor and mentee try to meet at a location that would be a midpoint and convenient for both. There is also a parent carpool list that parents can be placed on if they are interested in coordinating carpools to events with other parents whose children are in the program.
Please contact us if you would like to be added and receive a copy of this roster.
Who are the mentors and why do they want to be a part of the program?
Mentors are DFGOYC volunteers and students from a variety of different backgrounds. They have been interviewed, trained, had their references checked, and carefully matched with middle school students. Mentors have a variety of motivations for getting involved with the program. However, all mentors want to be a positive role model in a child’s life.
When will my child meet with their mentor? What kinds of activities will they do together?
Meetings will be at a day and time convenient to you, your child, and the mentor. There is no scheduled location or activity for the meetings. Rather, mentors will call your child to set up plans for the week. Activities range from going to the library, to visiting college campuses, to seeing movies, or sporting activities. All activities are agreed upon by you, your child, and the mentor.
The only events that are pre-arranged are monthly events that we hold for the entire organization. These events typically take place on Friday evenings or Saturday afternoons. You will be informed of these events by your child’s mentor, as well as by mailings that we will send out the week prior to the event.
What should I do if my child cannot attend a meeting or event with their mentor?
Have your child call his or her mentor and reschedule the meeting to a time that is more convenient. Be sure to keep the phone numbers of the mentor handy so that you or your child can call them when needed. If you cannot reach the mentor, please call Destined for Greatness Outreach Youth Center, Inc. at (877) 571-6614 Extension 1 and leave a message with the Youth Mentor Program.
What if family plans conflict with a meeting?
The mentor should compliment or add to family opportunities. Time with the mentor is not intended to displace time with the family. You should continue your normal family plans. The mentor and your child should plan their time together around your family’s normal schedule as much as possible. It may help to let your child and their mentor know about planned family events in advance to help avoid conflicts.
Can other family members or I go with my child and the mentor?
A mentoring relationship is special in part because it is a one-on-one relationship. Even teens that feel very close to their parents sometimes need to talk with friends outside of the family. The mentor is an adult friend with whom your child can talk about things that concern him or her. Please respect their private time together. Moreover, mentors are not baby-sitters and cannot be responsible for anyone except their mentee.
The mentor and your child will inform you about their plans each week. If at any time you are uncomfortable with their plans, please let us know. Mentors will be sensitive to you parental concerns and will try to find an arrangement that is acceptable to you.
How can I be sure that the mentor will support my rules and regulations?
In the beginning, talk to the mentor about any rules or regulations that you expect to arise in his or her relationship with your child. If you have strict rules about curfew, activities in which your child may not participate, etc. then please discuss these with the mentor. By making this information known at the beginning, you can help avoid misunderstandings later.
What if the mentor says things with which I do not agree?
No matter how carefully we match mentors and mentees, you may find that some areas of your beliefs and ideas differ with those of the mentor’s. If there are important issues to you, please let the mentor know. You can request that the mentor NOT question your most important beliefs or values when with your child.
Who will pay for activities of the mentor and my child?
Mentors and mentees always pay for their own expenses. If there is a cost for an activity, then you or your child will be responsible for the youth’s fair share. Monthly events at DFGOYC are cost-free; we also provide the mentors with many low-cost or no-cost activity suggestions. As with any friend, mentors may treat your child occasionally, but it should not be expected on a regular basis.
How often should I be in contact with the mentor and how much should I say about family problems/ concerns?
Get to know the mentor well enough to feel comfortable with him or her being with you child. Before each meeting, discuss the plans and times for returning home. Try talking directly to the mentor about your concerns, but please avoid talking to the mentor about your child in front of your child. If there is something the mentor should really know, then call them when your child is not around.
What if there are concerns or questions I don’t want to discuss with the mentor?
Please feel free to contact the President, Mr. James Kyles Jr by phone at (877) 571-6614 ext.1 or email at firstname.lastname@example.org. He is here to make the Youth Mentor Program work for students, mentors, and parents. A Steering Committee member will call you several times during the school year to see how things are going. But don’t wait for them to call! We would like to know about anything that concerns you as soon as possible.