SAY: Confident Voices Mentor Project Enrollment Form

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The Mentor Project is an 8-week program, taking place entirely on Zoom for kids & teens who stutter in NYC and the Tri-state area! ***

At SAY, everyone has as much time as they need to speak. Participants are encouraged to be confident in their unique and powerful voices, and to express themselves freely as they connect with peers in an environment where it is really, really ok to stutter.

In our popular spring Mentor Project, we invite a select group of adult Mentors who stutter to join our group of participants each week. Young people who stutter and Mentors will be paired with an expert Teaching Artist and will collaborate on creating an original artistic piece. Together, groups will connect about stuttering, create deep bonds and participate in a variety of fun artistic exercises. Over the course of 8 weeks, we will explore themes relating to self-empowerment, hope, stuttering, anti-racism, and equality, and will channel our thoughts and feelings into beautiful artistic creations.

Most importantly, as always we will hang out, connect, and share with peers who stutter in a safe and chill online space!

This program is free of charge. Enrollment form must be filled out by a parent/guardian.

*** Are you new to Confident Voices and located outside of the NYC / Tri-state area? Wonderful to connect with you! Please email Kate (kate@say.org) or Aidan (aidan@say.org) to inquire about space.

Please fill out the form below to enroll your child in the Spoken Word Project! Space is limited.

Email *

Participant name (first and last) *

Mentor Project Dates (8-week program)

Participant date of birth: *

Participant age: *

Participant grade: *

Participant identifies their gender as: *

Female

Male

Transgender

Non-binary

Other

Participant t-shirt size: *

Parent / Guardian Name: *

Relationship to child: *

Contact number: *

FULL home address (including: street address, apartment #, city, state, zip code): *

Which timezone are you in? *

EST (Eastern Standard Time)

CST (Central Standard Time)

MST (Mountain Standard Time)

PST (Pacific Standard Time)

List of time-slot options (each participant will choose ONE):

Which Mentor Project time-slot would you like to enroll your child in? (choose one) *

Thursday Session (start date: April 29) THIS SLOT IS CURRENTLY AT CAPACITY

Friday Session (start date: April 30) THIS SLOT IS CURRENTLY AT CAPACITY

Saturday Session 1 (start date: May 1)

Saturday Session 2 (start date: May 1)

My child has access to the following device(s) to use during programming: *

ipad / tablet

laptop

chromebook

phone (with camera & internet capabilities)

desktop computer

my child does not have weekly access to a device

Required

What is the impact of stuttering on your child's life? *

Why is SAY important to your family? *

Do you agree to our Terms & Conditions below? (Must be filled out by parent/guardian) *

Yes

Terms of Agreement

1. Parents must notify SAY if their child will be missing part or all of a SAY program or event at least 24 hours BEFORE the SAY event begins. If your child is sick, will be late to, will leave early from, or will miss a SAY program or event, please contact Director of Confident Voices, Kate Detrick or Artistic Director of Confident Voices, Aidan Sank. SAY Cell Phone: (917)-697-7183.

2. SAY is supported by the community, and its programs are typically offered to its participants for much less than the actual cost of the program expenses. However, at this time, all Confident Voices sessions are being offered FREE (while space lasts).

3. SAY is a positive and safe environment. Accordingly, SAY reserves the right to ask a child to leave the company, in its sole discretion, whose behavior resembles the following: a) excessive violent/disrespectful behavior, b) excessive lateness or absences, c) any possession of drugs, alcohol, or weapons.

4. Attendance problems adversely affect SAY's programs, and ultimately your child's experience in those programs as well. Because of this, your child may be asked to leave the program if they are excessively absent. This decision will be made on a case-by-case basis at the Director and Artistic Director’s discretion.

5. I understand that due to COVID-19 restrictions, the Mentor Project is an online program, taking place using Zoom Video Communications.

6. Families and individual participants may not make contact with SAY employees via personal cell phones, email, or social media (Facebook, Instagram, Snapchat etc.). If a family wishes to make contact with a specific SAY employee, please contact one of the Directors via email (kate@say.org, aidan@say.org) or phone (917-697-7183).

7. Individual SAY employees are not permitted to accept gifts or monetary tips of any kind from families or participants. If a family wishes to give a greeting card or thank-you note to a specific employee, the card may not be presented directly to the employee, but can be given to one of the Directors to be passed along. In addition, express agreement from one of the Directors must be obtained in advance if a family wishes to provide any edible items to share with SAY participants and/or staff.

8. For good and valuable consideration we hereby consent to and authorize the reproduction, publication and use by SAY of any photograph, picture, sobriquet, voice or likeness of my child.

9. I further give permission and consent that any such photographs may be published and used by SAY and the American Camp Association® and its agents, to illustrate and promote the participant experience, SAY and its programs, or the American Camp Association.

In accordance with applicable federal laws, SAY provides equal opportunities to employees and applicants without regard to age, race, religion, ethnicity, veteran status, disability, gender identity, or sexual orientation.