Group Mentee Application

Group Mentee

First Name*

Last Name*

Date of Birth*:

Phone*

Email*

T-Shirt Size*:


School Attending*

Current Grade Level*

Student ID Number*:

Gender*


Sexual Orientation*:


Ethnicity*


Medical Conditions*:


Medical Conditions Allergies (write NONE if this doesn't apply to you)*:

Medical Conditions Others (write NONE if this doesn't apply to you)*:

Select which categories apply to you*:


Other category if not listed above (write NONE if this doesn't apply to you)*:

Address*:

City*:


City if not listed above (write N/A if this doesn't apply)*:

Zip Code*:

State*:


Country*:


Family Household Income*:


Family Structure*:


Primary Emergency Contact Name*:

Primary Emergency Contact Mobile Phone*:

Primary Emergency Contact Email*:

Instagram @*:

Three Words To Describe Yourself?*

What do you do for fun? What are you interested in?*:



What qualities or personality would be good in a mentor for you? What common interests would
be important for you? Is there anything you would like to learn from this person?*:


How do you feel about having a mentor? Do you have any concerns?*:


I understand that personal information about me or our family is shared between Friends for Youth program staff and/or other referring parties solely for the purpose of supporting me, including offering needed resources to the family. By signing, I agree that Friends for Youth may communicate with school staff or other referring parties as needed and on a limited basis to provide support.

Friends for Youth is proud of its youth and its programs and occasionally shares photos of its mentoring programs on social media (no youth last names are used) and in written marketing materials to promote the programs. By signing, I agree that I may be photographed or videotaped during mentoring activities.

In order to participate in the Group Mentoring Program, I agree to hold Friends for Youth, Inc., and its agents and employees, harmless from any and all liability, actions, cause of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which may arise in the future, connected with an activity or participation in other associated activity.

I agree that this release and waiver agreement is intended to be broad and inclusive, as permitted by the law of the State of California, and that if any portion thereof is held invalid, the remainder shall continue in full force and effect. This release covers the entire agreement between myself and Friends for Youth, Inc., and it is considered to be a legally binding contract.