Royal Family Kids Mentoring Club Information

• There is no charge for the mentoring club.
  
• Mentors can provide transportion to and from all events. 
• The mentoring program runs throughout the school year.
• The child will be matched with a trained and cleared camp volunteer for one-on-one mentoring.
• All of the mentors and kids gather for two hours once a month at Rock Harbor Church in Costa Mesa for group activities.
• The mentors commit to spending at least 4 additional hours monthly with their mentee in one on one activities.
• One on one mentoring acitivities will take place in public places. Mentors are not allowed to take their mentees to their homes.
• Please compelte this application and read & electronically sign the:
  1. Medical Authorization
  2. Mentoring Club Prorgram Authorization
  3. Mentoring Club Caregiver & Staff Covenant 

For additional information regarding the Club and Mentoring Program, contact our Mentoring Director Deneé Grauberger at rfkclubrockharbor@gmail.com or 702-461-4934

This Royal Family KIDS Clubs And Mentors 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’ Club in any manner; it applies to all Club activities, including both individual meetings with a Club mentor and group meetings, functions, and events (the “Activities”).

I authorize the Royal Family KIDS’ Mentoring 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 or dentist 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.

This Medical Release Form will be used only as necessary in the circumstances. Every reasonable effort will be made to first notify a care giver listed below prior to the use of this Medical Release Form.

As the undersigned legal parent or caregiver, I request that my child, be allowed to participate in the Royal Family KIDS’ Clubs Mentoring Program. This Permission and 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 Club activities, including both one on one meetings with a Royal Family KIDS’ Club Mentor and group meetings, functions, and events. 

I understand that the number of children matched and admitted is limited by the number of mentors available, and that age and geography are also limiting factors.  As part of the matching process, I give permission for Camp staff to share my child’s Camper Application information (including social worker contact information) with Club leaders in order to better match my child to a qualified mentor.

I hereby give permission for my child to attend and participate in mentoring club activities and to be transported by their assigned mentor or other cleared mentoring club volunteers. I specifically authorize Royal Family KIDS to provide for, and arrange in my place, necessary medical care, as stated in the Medical Release Form. 

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’ Club, the local Club’s mentors, Club leaders, volunteer assistants, the host church, and any designated driver of a van, bus, car, or other vehicle used in connection with any of the Activities (“Released Parties”) 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.

Photo/Video Release, Permission to Use Image

Photos and videos of club activities are used for fundraising and volunteer recruitment. I hereby give For The Children and/or the program sponsor churches (RockHarbor and St. Andrews Presbyterian) my free and unlimited consent and permission, waiving all claims for any compensation by reason thereof or for damages by reason thereof, to use, to publish, republish or exhibit in the context of its work—with or without identification of me by name—photograph/s and/or video images and story described below, for purposes such as promotional, printed or published materials, illustration, social media and/or online content.

In doing so, I confirm with For The Children that all individuals within the photograph/s and/or video images and story have given their expressed consent and permission to use their likeness in any and all print and digital media, and have waived all claims for any compensation.

I further understand the master of the content remain the property of For The Children and that there will be no restrictions on the number of times that they can be used.

Mentoring Staff Commitment

• The mentor matched to your child will be drawn from volunteers that have previously served at a Royal Family Kids summer camp.
• All mentoring club volunteers have undergone training and have cleared background checks.
• One on one mentoring activities will take place in public places. Mentors are not allowed to take their mentees to their homes or participate in overnight activities.
• Mentors commit to communicating with you in a timely manner regarding proposed mentoring activities, activity locations, club events, pick-up/drop-off times and any changes to previously agreed upon dates and times.
• The Mentoring Director will contact you during the year for your feedback about the Club program and your child’s mentor volunteer. 
• You may contact the Mentoring Director at any time if you have any questions or concerns. 

Caregiver Commitment

• I understand that the Royal Family Kids Mentoring program runs through the school year and provides children with a minimum of four hours per month of one-on-one mentoring and a monthly, 2-hour mentoring club gathering with all mentors and mentees at RockHarbor Church in Costa Mesa.
• I agree to work with the Mentor to ensure that my child is available for mentoring activities.
• I understand that I will need to be home at agreed upon drop-off times and will communicate with my child’s mentor any changes to previously agreed upon pick-up/drop-off locations, dates and times.
• I understand that the goal of the mentoring program is to develop a healthy relationship with a positive role model, and is not a reward for good behavior. I agree not to withhold permission for outings with the Mentor or for club activities as punishment for my child’s misbehavior.
• I understand that Mentors are not allowed to take siblings or other children not enrolled in the mentoring program to club events or mentoring outings.
• I understand that the 2025 mentoring program will end after 05/16/25 and further activities with the mentor will not be allowed after this date. Exceptions will require approval by the Mentoring Club Director.