Overnight Consent Form

Please make sure you have spoken to your Mentoring Coordinator and received confirmation from them that your match can have an overnight visit at least one week in advance. Please note that matches are not allowed to have an overnight visit during the first year of their match.

Overnight Consent Form

Instructions

Please only fill out the appropriate section below (ex: Parents/Guardians, only fill out Parent/Guardian section). Once you have filled out your section select "Save and Continue Later" at the bottom of the form.

Please select your Mentoring Coordinator(Required)

Adrianna Kipp

Alexis Gardner

Alysha Vivian

Ezra Loggin

Overnight Details

This section can be filled out by both the parent/guardian and the mentor.

Overnight Start Date(Required)

Overnight End Date(Required)

Where will the overnight be occurring?(Required)

Please share where the match will be staying during their overnight visit. E.g., mentor's home, a campground, etc. Please be as specific as possible.

What phone number can the mentor be reached at during the overnight visit(Required)

Please describe the plan for the overnight visit.(Required)

Please include the following information: itinerary, sleeping arrangements (separate beds/sleeping bags), planned pick-up/drop-off times, privacy considerations (changing showering, etc.), and the presence of other people during the visit if applicable (e.g., if someone else is at the home) .

Parent/Guardian

Child/Youth Name(Required)

First Last

Parent/Guardian Name(Required)

First Last

Date Parent/Guardian Signed(Required)

Mentor

Mentor Name(Required)

First Last

Date Mentor Signed(Required)

Mentoring Coordinator

Mentoring Coordinator Name(Required)

First Last

Date Mentoring Coordinator Signed(Required)