Student Registration Form
For the Parent to fill out for registering their student
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Email *
Name of Student *
Name of Parent(s) or guardian *
Parent/guardian phone # *
Home address *
School and grade of student *
Student's birth date *
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Student's Shoe size *
Student's Shirt size *
What are the interest and hobbies of the Student? *
What social media forms does the student most use. *
Required
Does the student have a cell phone? *
If the student has a cell phone, what is their number?
Does the student have email? *
If yes to email, what is the the students email address?
Which ways of communication  is acceptable for Mentors/staff to communicate with your student? *
What is the way to communicate with you, the parent/guardian? *
Will transportation of the student to Saturday events be a problem? *
Which weeks will work for your student to go to New Hampshire? *
Required
List possible problems, limitations, and or environmental situation: *
Other comments or concerns:
Photo consent agreement: Your student's photo may be taken during Mountain Mentor activities for social media, news letters, promotion, etc. *
I voluntarily agree to participate in the Mountain Mentors program for one year. I will treat my mentor and others participating in the Mountain Mentors program, with the utmost respect With truth, honesty compassion and trust. I will be expected to meet with my mentor at the required monthly activities. I will be expected to have weekly phone contact with my mentor. I will abide by the rules and regulations of the Mountain Mentors program. I will participate in a weeklong wilderness expedition with my mentor in a team setting. I recognize that this trip is for the benefit and growth of me and the others in the team I will be working with.   My clicking "agree" indicates that I understand the above requirements and agree to meet them. *
Parent Signature (Please type full name) *I____________________________for myself, my child, and my/our heirs, executors, administrators and assigns, do hereby waive, release and forever discharge and agree to indemnify and defend Mountain Mentors, its members, officers, administrators, employees, volunteers, servants, and agents from and against all claims, demands, or causes of action by any person or entity, for any theft, loss, cost, injury, death, or damages whatsoever arising from or claimed to arise from or in any way connected with the named child’s participation in the Mountain Mentors program and activities. By typing name below you are accepting and agreeing to the terms above. *
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