Race 4 Excellence Inc

Race 4 Excellence Inc

Mentee Application
Requirement of the participants
Race 4 Excellence will begin promptly at 1 PM and end at 5 pm sharp. We will meet at MS 35, 272 MacDonough St, Brooklyn, New York 11233 near the corner of Lewis Ave. We will meet one Saturday a month (unless there is a special trip or event) Your son can't miss more than 3 of these meetings. On the third missed date, he will be dropped from the program.

The schedual will be provided upon acceptance of the application and there may be field trips added to the schedual. You will be given advanced notice of any changes.
Mentee Name*

First NameLast Name
Age*
Gade*
Does he have any allergies?*
Does he carry medication for his allergies?

Parent/Gardien*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred form of contact

textphone callemail
Emergency Contact - if primary can't be reached*

First NameLast Name
Phone Number*
Please enter a valid phone number.

Important Information
As a parent/guardian, you are responsible for making sure your child(ren) are picked up promptly at 5 pm. We understand that emergencies come up. You are still responsible for making sure your child(ren) are picked up at 5 pm. Please contact the administrator if there is a change in plan or a different person will be coming to pick up your child.

Children allowed to be dismissed on their own will be dismissed at 5 PM and Race 4 Excellence will not be responsible for them once the program ends.
Please check one of the following. If at any time there is a change to your choice, written authorization will be required.*

By choosing this option, I give R4E permission to release my child(ren) at the end of programMy child will be picked up by a parent or guardien
I hereby grant Race 4 Excellence and its agents the right to video/audio tape/photograph my child, named below (known hereafter as “he/his”), his likeness/voice/performance in connection with Race 4 Excellence and 500 Men Making a Difference and that said video/audio tape/photographs may be broadcast or otherwise transmitted by Race 4 Excellence or 500 Men Making a Difference, its successors or assigns. I agree that you may copyright said video/audio/photograph. I further agree that his likeness/voice/photograph and participation in the program may be used in connection with publicity about Race 4 Excellence and/or 500 Men Making a Difference. I understand that the recorded material will not be used for commercial gain but excerpts may be used in compilations or other promotional activities. I release Race 4 Excellence and 500 Men Making a Difference and their agents, successors and assigns from further claims or demands coming from the use of materials you may record in which he appears or can be heard.

By selecting one of the options below you will agree or disagree with these terms
Name*

First NameLast Name
Date*
Consent options*

I consent to the above terms of the photo/video/audio releaseI claim the rights to any photo/video/audio representation of my child

My Products*

Mentee Application FeeMentee application fee

$10.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

Race 4 Excellence Inc

Important Information

Payment Methods