If you are interested in having a mentor or you are interested in your child having a mentor, please fill out the following form.

    Please answer all of the following questions as completely as possible. These answers will assist in the matching process.

    Please read carefully before submitting:

    Thank you for your interest in having a mentor. All information provided in this application is confidential and will only be used as a means to provide a successful mentoring match.

    1. Understand that at any time I have questions or concerns about my child’s mentor, I am able to talk to the Program Administrator.
    2. Acknowledge that this consent form will be filed at the SCCYI: The Center.
    3. Understand that my child will be contacted by the Program Administrator to supervise and monitor the relationship with their mentor.
    4. Understand that my child cannot have contact with their mentor outside of the scheduled sessions and planning of sessions.
    5. Agree to inform the Program Administrator if I choose to withdraw my child from the program.
    6. Release the Swift Current Community Youth Initiative: The Center (including all partners) and their employees, directors, and volunteers from any cause or action
      or claim for damages arising form my child’s association with the Mentoring Program, or with the Swift Current Community Youth Initiative in its entirety.
    7. Consent to my child being transported to and from activities and sessions by the mentor.

    By continuing, I agree that all of the above information is true and agree to have my child participate in the SCCYI Mentoring Program.