Men of Integrity Mentoring Registration form

Men of Integrity mentoring program is a developmental and skill building program that focuses on the growth of the young male students within the community and surrounding areas. To help improve academic achievement, self- esteem, social competence, and avoidance of problem/high-risk behavior by providing a relationship with a caring adult friend who works to help youth achieve their potential. Exposing the young men to positive environments i.e., learning about Communication & Social Skills, Mental & Physical Health, Education, and Financial Literacy. We believe that working as a unit builds unity and growth within our young men of tomorrow. We are dedicated to ensuring that each young man, regardless of their background has the equal access to the resources that are needed to achieve success.

Men of Integrity is a 501(c)(3) tax-exempt nonprofit organization currently based in Winter Park, Florida. Our program primarily focuses on the central florida areas with the focus of expanding to surrounding neighborhoods. Focusing on providing guidances to the underprivileged young men of the communities. We strive to increase situational awareness in our communities, and promote opportunities that expose our youth to positive environments for expansion and growth.

Pillars of our program

  • Education
  • Sustainable Living
  • Physical & Mental Health
  • Social Skills (Life Development)
Program cost 

One-time fee per year ($40.00/mentee)

All program participants MUST pay the one-time fee and to retain their membership for the year. This flat program fee of $40.00 is applied in support of the operations of our mentoring program. The funds go directly to the Men of Integrity Mentoring Programs Inc. bank account. This yearly fee helps with an assortment of activities for the program. 

NOTE: This cost does not cover the price of field trips and/or certain activities that may not be covered by the programs stipend.

Program Shirts

Program T-shirt cost: ($15.00 each)

Pay: 

Cashapp: $MOIMENTORING (ANTWON CARTER)

PAYPAL MOIMENTORING407@GMAIL.COM

Money orders should be made out to:

Men of Integrity Mentoring Program

Please add your son(s) name to the memo section line.

MOI Program shirts are required to be worn at each mentoring meeting as well as any special events that the program holds. The MOI program shirts are created by a vendor which can be purchased through the MOI program directors. A receipt for the purchase will be provided and orders for program shirts are submitted weekly. No shirt will be provided if no payment has been received. (Those with previous shirts are good to go as long as the shirts are in good condition and fits properly.)

Email *
Mentee Name *
First and last name
Mentee Name
First and last name
Mentee Name
First and last name
Mentee Age(s) *
Mentee Age(s)
Mentee Age(s)
Mentee Age(s)
Mentee Date of Birth *
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Mentee Date of Birth
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Mentee Date of Birth
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Mentee Date of Birth
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Mentee School *
Mentee School
Mentee School
Mentee School
Mentee Grade *
Mentee Grade
Mentee Grade
Mentee Grade
Parent(s) Name (Primary Guardian) *
Phone number *
Email Address: *
Parent/Guardian 2:
Phone number
Email address:
Emergency Contact Name *
Emergency Contact Phone number *
Any known allergies: (as students will have snacks, food and drinks) 
 *
Any known elements please list here: (example: ADHD, Bipolar etc.)
 *
CONSENT TO MEDICAL TREATMENT
 *
In an emergency, when parental permission is not available, I hereby give my
permission for a staff member of Men of Integrity Mentoring Program the consent
to call 911 for any medical treatment needed for my child to be taken to the nearby hospital if necessary to:
(List name of hospitals, if there is a preference)
Photographic and Video Release
 *

I hereby grant, Men of Integrity Mentoring Program the right and permission, to any photographs and videos taken of the minor named below to be used for all media, advertising, publicity, and promotion. 

I hereby certify that I am the Parent and/or Guardian of {menteeName} a minor under the age of 18 years, and hereby consent on behalf of said minor to the use of any of the photographs and videos taken within the program listed above

Required
Program Code of Conduct
Dear Students, Parents and Guardians:
Who we are as individuals makes up what we are together, whether family, school, community, or nation. Mentees in the Men of
Integrity Mentoring (MOI) Program are expected to follow the golden rule:

TREAT OTHERS AS YOU WOULD LIKE TO BE TREATED

We believe that during the youthful years are the best time to grow and learn from mistakes. We emphasize learning over consequences and are guided by a developmentally appropriate philosophy. We have established the R.A.S (Respectable, Accountable and Sustainable) mentality in our program as an overall framework for our young men that will pass through and grow within our mentoring program. We know that we all learn differently and thrive best in an atmosphere where the opinions and rights of all are honored and respected. Therefore, our core values are:

Demonstrate respect for yourself and others.
Demonstrate courtesy to others.
Behave in a responsible manner.
Regular attendance.
Take participation in program seriously.
Dress appropriately. Must wear a belt no sagging pants
Cooperate with leadership.
Respect others property.
Avoid violation of student code of conduct.

The Men of Integrity Mentoring Program has a Creed that each mentee has received.
MOI Creed: 
I believe in you, You believe in me, We believe in us, I will be great, You will be great, We are not ordinary, We are becoming extraordinary, We are the Men of Integrity (Speak) More Life!!!!

We believe in the support of the parents to aide in their child’s growth, and contributions that make our program, and communities unique. The following sections will further outline our most important guidelines for making your child’s experience productive and positive.

Mentees are expected to:
Treat others the way in which they would like and expect to be treated
Know and exercise positive models of behavior and good manners.
Accept responsibility for their actions and the consequences of inappropriate behavior as outlined in the code of conduct.
Respect the rights of others, including the right to learn in an environment that is orderly and disciplined.
Adhere to the rules of MOI.

Every parent/guardian are expected to:
Model positive behavior and good manners.

Work cooperatively, attend, and actively participate with the mentoring staff, events, and meetings to ensure the well-being and development of all children.
MOI & WPCC FIELD TRIP TRANSPORTATION
 *
I give MOI and the WPCC the rights to transport my student(s) (mentee(s))To all special events for Men of Integrity.

By signing below, I understand that transportation is offered is optional and not guaranteed by Men of Integrity volunteers, and the Parks and Recreation Department of the city of Winter Park.

I recognize and acknowledge that Men of Integrity is not a common carrier nor is it in the business of providing transportation services to the public. I also recognize and acknowledge that there are certain risks of physical injury to vehicle passengers.

I voluntarily agree to assume the full risk of any injuries, damages, or loss, regardless of severity, that I may sustain as a result of participating in all activities connected with and/or associated with receiving transportation services, including, but not limited to, injuries, damages, and loss arising out of negligent operation or supervision of the vehicle.

I do hereby fully release and forever discharge, hold harmless, and indemnify Men of Integrity, and the Parks and Recreation Department of the city of Winter Park. And all participating staff, volunteers, agents, and assigns, or any and all of them (collectively the “Released Parties”), from any and all claims, causes of actions, suits, and liabilities of any kind or character whatsoever, known or unknown, suspect and/or unsuspected, in contract or in tort, at law or in equity, which I might have against the Released Parties, jointly or severely, for or by reason of any matter which relates, in whole or in part, directly or indirectly, to being transported for whatever reason.
WPCC BUS/VAN PERMISSION

In case of an emergency, The Winter Park Recreation Division will contact the person (s) listed below. If the said party cannot be reached and emergency care is required, the City of Winter Park Fire Department/Rescue services will be called. In case of an emergency outside the City Limits, 911 emergencies will be activated. Costs for these services are responsibility of the below said persons.
Required
Parent/Guardian Signature *
Parent/Guardian Signature
Date *
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A copy of your responses will be emailed to .
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