HOW TO APPLY - To have your child considered for the ROYAL FAMILY KIDS GROUP MENTORING PROGRAM, please complete this application. You will be contacted by the Mentoring Program Director after the application is completed

Yes, I would like my child to be considered for the RFK GROUP MENTORING PROGRAM this year.

LIMITED ENROLLMENT AGREEMENT FOR CAREGIVERS: I understand that the number of children admitted is limited by the number of staff available. As part of the process, I give permission for Mentor Club staff to share my child's Mentor Cub Application information (including social worker contact information) with Mentoring Program leaders in order to better serve my child.

As the undersigned legal parent or caregiver, I request that my child be allowed to participate in the Royal Family KIDS Mentoring Program at Coastline Community Church. This Activities Permission & Release Form is effective on the date of my signature below, and will remain in full force and effect as long as my child participates with Royal Family KIDS in any manner; it applies to all Mentoring Program activities, including meetings with a Royal Family KIDS Mentoring Program and group meetings, functions, and events (the "Activities"). I hereby give permission for my child to attend and participate in the Activities. I specifically authorize Royal Family KIDS to provide for, and arrange in my place, necessary medical care, as stated in the Medical release Form on the reverse hereof. In consideration for permitting my child to attend and/or participate in the Activities, I do hereby release, and on behalf of my child release, Royal Family KIDS Mentoring Prgram, the local Mentoring Program leaders, volunteer assistants, and Coastline Community Church, from any and all claims for injuries, losses, damages, costs and expenses that I, and/or my child, might have against the Released Parties, arising out of, or in any way relating to, my child and the Activities, and I agree to hold the Released Parties harmless from any loss arising from such claims.

I certify that I have read, understand, and agree to the provisions of this Activities Permission and Release Form, including the separate Medical Release Form on the next page.

A recent physical examination is not required to participate in the club. If you know the date of the child's most recent exam, please indicate below. If this information is unavailable, you can leave this section blank.

This Medical Release Form is effective on the date of my signature(s) below, and will remain in full force and effect as long as my child participates with Royal Family KIDS Mentoring Program in any manner; it applies to all RFK Mentoring Program activities, including the meetings with a Mentoring Program and group meetings, functions, and events (the “Activities”). I hereby give permission for my child to attend and participate in the Activities. I specifically authorize Royal Family KIDS Mentoring Program to provide for, and arrange in my place, necessary medical care. I authorize the Royal Family KIDS Mentoring Program Director or any designated adult, in whose care my child has been entrusted, to arrange for and consent to any x-ray examination, anesthetic, and/or medical, surgical and dental procedure and treatment, and hospital care, to be rendered to my child under the general or special supervision, and on the advice of any physician ordentist duly licensed by an appropriate regulatory agency, or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of such physician, dentist or hospital. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical, dental and/or hospital services rendered to my child pursuant to this authorization. Should it be necessary for my child to be transported home or to medical facilities due to medical reasons or otherwise, the undersigned shall assume all transportation costs

Royal Family KIDS Mentoring Program believe that parents & caregivers are our most important allies in helping children develop good values and achieve their potential. Please review this Commitment, and sign below to indicate your agreement to work with Mentoring Program Leaders to create the best environment for your child/ren.

My Commitment as Parent and/or Caregiver: 1. I understand that the Royal Family KIDS Mentoring Program at Coastline Community Church runs through the school year and provides a once-a-month Mentoring Program event on the 3rd Saturday of each month from 10 a.m. until 1 p.m., September 2024 through May, 2025. I will contact the Mentoring Program Director as soon as possible if plans must be changed due to illness or emergency. 2. I understand that attending RFK Mentoring Program regular meetings develops a healthy relationship with a positive role model, and is not a reward for good behavior. I agree not to withhold permission for Mentoring Program activities as punishment for my child’s misbehavior. 4. The RFK Mentor Progam at Coastline Community Church meetings will end at 1 p.m. and my child needs to be picked no later than 1:30 p.m. at Coastline Community Church. I understand that RFK Mentor Program staff may NOT provide transportation, and will only dismiss my child to an approved adult caregiver OR an approved emergency contact (photo ID required). I understand that Mentoring Program meetings are not permitted over the summer and Royal Family KIDS Mentoring Club of Coastline Community Church supervision will end on May 17, 2025.                                                              

I hereby give my permission for the adults (18+ YEARS OLD) listed below to serve as authorized emergency contacts and to pick up my child/ren from a Mentoring Program meeting or event. I understand that the Emergency Contact adult(s) named below must show a current picture I.D. to the RFK Mentoring Program volunteer before the volunteer may dismiss the child/ren in their care. Any changes to this form must be submitted (with approved signature) to the Mentoring Program Director in writing. ADULTS authorized to pick up my child serve as emergency contacts, including the primary caregiver.