P. O. Box 5194 Huntsville, AL 35814 (256) 714-8921 Contact www.100bmogh.com

Who should we contact in case of emergency?

I authorize the 100 Black Men of Greater Huntsville to contact the current school of my son to obtain teacher evaluations and recommendation, achievement and aptitude test results, attendance and discipline records, transcripts/report cards.

100 BMOGH Mentoring Program Parent/Guardian Agreement

 

 

By allowing my son to participate in the 100 BMOGH "Men of Tomorrow" (MOT) Mentoring Program, I agree to:

• Allow my child to participate in the 100 BMOGH MOT Mentoring Program and to be matched with a 100 BMOGH Mentor or participate in the 100 BMOGH Group Mentoring Program.
• Follow and encourage my child to obey all rules and guidelines as outlined by the program coordinator, training, program policies, and this agreement.
• Support my child in this match by allowing him to meet with his mentor / and or teachers at least eight hours per month and have weekly contact with his Mentor.
• Support my child being on time for scheduled meetings or have him call the Mentor or Mentoring Chair at least 24 hours beforehand if unable to make a meeting.
• Be responsible to get the Mentee to the designated program facility in a timely manner. Only parents, legal guardians, mentors, or designated individual(s) will be allowed to pick up a from the facility.
• Regularly and openly communicate with the Mentoring Chair or Co-Chair as requested.
• Inform the Mentoring Chair or Co-Chair if I observe any difficulties or have areas of concern that may arise in the match relationship.
• Participate in a closure process when that time comes. A closure process may be voluntary or involuntary.
• Notify the Mentoring Chair or Co-Chair if I have any changes in address, email, or phone number.
• Provide the Mentoring Chair Co-Chair and the Mentor with any updated health insurance information for my child.
• Provide a copy of the Mentee Report Card (upon receipt)

I agree to follow all the above stipulations of this program as well as any other conditions as instructed by the Mentoring Chair or Co-Chair at this time or in the future.

Assigned Mentee Information

Three Strike Rule Agreement

In order to maintain acceptable attendance in the "Men of Tomorrow Mentoring Program, the 100 Black Men of Greater Huntsville (BMOGH) have composed a Three Strike Rule. This rule will hold each participant accountable for their attendance.

If a participant has a valid reason for not attending the Saturday workshops or other activities hosted by the chapter, they must advise the Mentoring Chair or Co-Chair or there representative prior to such activity. You may call and leave a message on their cellphone in order that our records will indicate an excused absence.

Unexcused absences will be recorded, and three such absences will mean that the student can no longer participate in the program. We hope that all parents will understand the importance of regular attendance and realize why this rule was initiated.

Tardiness is another major concern. In order to get the full educational value of the program, everyone must be on time. In the interest of developing punctuality, anyone arriving twenty (20) minutes after the Saturday program has begun will be considered absent.

My signature represents my agreement to abide by the Three Strike Rule.

My signature represents my agreement that my son will abide by the Three Strike Rule.

PARENTAL CONSENT
Trips or Events

100 Black Men of America, Inc. and 100 Black Men of Greater Huntsville (BMOGH) does not carry an accident insurance policy to help cover the cost of accidental injuries to any child on a BMOGH sponsored trip or event.

I certify that I am the parent or legal guardian of the child named above. I have read the above statements regarding accident insurance and/ or liability coverage on 100 BMOGH or its representative to seek, authorize and grant consent to any qualified health care personnel to provide all necessary or appropriate medical treatment to the child for any illness or injury. 100 BMOGH and its representatives are released from any and all claims and causes of action that may arise out of such actions.

I understand that any accident/incident related expenses, including but not limited to, all costs of medical attention and treatment incurred, except for that covered by other applicable insurance, will be my responsibility. I consent to my child's participation in this activity.

I acknowledge, understand, and assume all risk inherent in the trip or event described above, including bodily injury, partial or total disability, death, and damages which may arise from there. These risks and dangers may be cause by the negligence of the participant or negligence of others, including members of 100 BMOGH, its agents, other mentees, and assignees. It is further acknowledged that there may be risks and dangers not known to me or that are not reasonably foreseeable at this time.

It is the purpose of this agreement to exempt, waive and relieve 100 BMOGH from liability for personal injury, property damage, and/or wrongful death caused by the negligence, if any, of 100 BMOGH, its agents, other mentees, and assignees. I acknowledge that I have read the above agreement and have not relied upon any other representations made by 100 BMOGH, its agents, other mentees, and assignees.

Men of Tomorrow Workshop &
Field Trips Participant Rules

1. No usage of profanity

2. No hats or head coverings

3. No wearing of gang colors or gang paraphernalia

4. No comments of a sexual nature or orientation

5. No horseplay (touching or hitting of other participants)

6. No talking or interrupting the group during discussion time

7. BE respectful towards others at all times!

8. DO bring your enthusiasm, eagerness, and creativity!

9. DO come to planned meetings and activities ready and willing to participate

10. Pants up (No sagging), Belts on, Shirts Tucked in Pants, and Shoes tied.

11. Adhere to other rules that may apply 12. Have Fun and Enjoy the Challenges!

WORKSHOP PARTICIPANT AGREEMENT

I have read and understand the "Men of Tomorrow" Workshop Participant Agreement, and I will agree to adhere to the principles and procedures listed above. I also understand that additional rules and regulations may be added from time to time and that they become a part of this agreement. Should I break this agreement, I understand that I may lose the ability to participate in workshops and field trip activities and I also understand that inappropriate behavior could result in a civil or criminal lawsuit.