Mentor Registration Form

Thank you for your interest in becoming a mentor! We are excited to have you join our team. Please fill out the form below to apply as a mentor.
Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number:
Please enter a valid phone number.
Email:
example@example.com
Please select the day and time you are available to voulunteer:

2nd Saturday from 10:00AM to 12:00PM (Noon)4th Saturday from 10:00AM to 12:00PM (Noon)Both
Please briefly describe your experience working with youth or any relevant background you feel would be helpful as a mentor:
Emergency Contact:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Backgroung Check Disclosure and Consent:

As part of our commitment to maintaining a safe environment for our mentees, all volunteer mentors are required to undergo a background check. By signing below, you consent to a backgroung check and authorize us to gather any necessary information related to this process.
Date:

MonthDayYear
Date
Please Print Name:
Signature

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By submitting this form, I agree to follow all guidelines, policies, and procedures set forth by the Order of Solomon mentoring program. I understand that my participation as a mentor is contingent upon successful completion of the background check and approval by the program organizers.
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