EmailMeForm
PARENTAL CONSENT FORM
for enrichment opportunities.
Student Name
*
First
Last
Student ID
*
Grade (fall 2023)
School where enrolled
Email to be used for contact
*
My student is allowed to participate in sessions for
*
Mentoring
Tutoring
Book Club
other
My student has participated in a program previously and is interested in continuing:
My student has previously worked with a volunteer (mentor or tutor) and is interested in reconnecting:
I, the undersigned, being the parent or legal guardian of the student named above, give permission for student participation in all activities as indicated. I understand that indicating interest does not guarantee placement for my student.
Name of guardian
*
First
Last
Day phone #
###
-
###
-
####
Guardian e-mail
*
Signature (Do not leave blank)
*
Clear
On laptops and computers, use your mouse.
On smart devices, use your finger or stylus.
Printed forms can be mailed to you. Call 447-ViPS.
