Alpha Esquires Mentoring Program
The purpose of this form is to recruit students to participate in the Alpha Phi Alpha Fraternity, Inc. - Go To High School Go To College Alpha Esquires Mentoring Program during the 2023-2024 school year. This program is for students enrolled in 6th through 12th grades living in Henry County, Spalding County, Butts County, Lamar County, and Upson County. This program will consist of activities to be held in-person on a monthly basis at McDonough Middle School (175 Post Master Dr., McDonough, GA). Interested parents/students should complete the form below. If you have additional questions please contact our program mentors at esquiresmentoringteam@gmail.com. This form must be completed by November 4, 2023.
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What county does the student live in? 
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First and Last Name of your child
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Grade level of your child
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Does your child have any allergies (food or non-food related items)?  *
Parent/Guardian First and Last Name (parent #1) 
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Parent/Guardian Phone Number (parent #1) 
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Parent/Guardian Email (parent #1)
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Parent/Guardian First and Last Name (parent #2) 
Parent/Guardian Phone Number (parent #2) 
Parent/Guardian Email (parent #2)
I give my child permission to participate in the Alpha Phi Alpha Fraternity, Inc. Mentoring program that may be remote and/or in-person in the future with respect to McDonough Middle School, the Georgia Department of Public Health, and CDC Guidelines:
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Parent or Guardian, by signing your name below you validate that the above statement/response is true:
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Parent/Guardian, by entering your first and last name in the box below, you are effectively providing your signature that the information provided is true and accurate and you are also agreeing to the following statement; I acknowledge that my child and I have read, and understand the requirements of participating in the Alpha Esquires mentoring program and we agree to the above terms. I further acknowledge that my child and I have freely and voluntarily agreed to indemnify and hold harmless Alpha Phi Alpha Fraternity, Inc., Rho Sigma Lambda Chapter, individual Brothers of Alpha Phi Alpha Fraternity, Inc., and participating volunteers (collectively, “Releasees”) and waive all claims I, my child, and third parties acting on behalf of my behalf and my child’s behalf may have against the Releasees. I further consent to have my name, image, voice, likeness, speech, and biographical information and that of my child (“Likeness”) captured by photograph, videotape, and/or otherwise recorded by Alpha Phi Alpha Fraternity, Inc., Rho Sigma Lambda, individual brothers of Alpha Phi Alpha Fraternity, Inc. and participating volunteers as they see fit. I grant the above the right to use my Likeness for any purpose, commercial or non-commercial. This grant of permission is made on a royalty-free, perpetual, irrevocable, non-exclusive basis, and will apply in any media known or later invented, and with the express understanding that I will not be given a right of approval or advance notice of any particular use of my Likeness.
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