2. PARENT PERMISSION FORM
4. Parent/ Legal Guardian (1)
6. Name*
8. Address*
10. City*
11. State*
12. Zip*
14. Cell Phone*
15. Home Phone
17. Email*
19. Parent/ Legal Guardian (2)
21. First Name
23. Address
25. City
26. State
27. Zip
29. Cell Phone
30. Home Phone
32. Email
36. 1. I certify that I am the Parent/Guardian of:*
37. Please select*

    1. Yes

    1. No
39. 2. I give full approval and permission for my child to participate in the Bowie Youth & Family Services Mentor Program. *

    1. Yes

    1. No
41. 3. Permission for Mentor to provide food for student:*

    I give permission for the mentor to provide food, either lunch or snacks, for my child, as appropriate.

    1. Yes

    1. No
43. 4. Permission to contact student outside of school hours:*

    I give permission for the mentor to contact my child outside of school hours by phone, for the purposes of following up with the student and enhancing the relationship.

    1. Yes

    1. No
45. 5. Permission to share student’s school grades:*

    I give permission for the grades of my child to be shared with the BYFS Teen Mentor Program staff to assist in facilitating the best match with a mentor, for my child. Grades will be shared with his/her mentor, in order to assist the mentor in having an understanding of my student’s needs.

    1. Yes

    1. No
47. 6. Permission for verification of attendance:*

    I give permission for the assigned mentor to verify my child’s attendance on planned meeting days.

    1. Yes

    1. No
49. Parent/Guardian Initials*
50. Date*
    Date
51. Parent/ Legal Guardian (1)
53. Student Initials*
54. Date*
    Date
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field