Parent/Guardian Consent – Steel Mentoring for Boys

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Parent/Guardian Consent and Liability Release Form

I (name)*

give my consent for my son (name)*

to participate in the S.T.E.E.L Mentoring Program For Boys, Douglasville, GA Youth Mentoring Program. 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 S.T.E.E.L Mentoring Program For Boys, and its agents 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.

Signature*

Date

Print Name*

Relationship to child*

Address*

City*

Zip*

Home Phone Number*

Mobile Phone Number*

Work Phone Number*

Email Address*

Language Spoken by Parent/Guardian

Emergency Contact and Phone(s)*

Parents / Guardians will be responsible for transporting your child to attend the monthly meeting. Parents / Guardians will provide written consent and waivers required for special events or group outings.