2025 Bee the Difference Mentoring App

Bee Mentee Application 2026 (Girls 13-18)

Some Preteens (age 12) may be considered
Thank you for your interest in our Mentoring Program!

Please complete the application in full and sign below for your child to be considered. Once received, we will contact you to discuss enrollment.

Our mission is to provide monthly check-ins and group sessions that offer insight, guidance, and empowerment—helping each young person develop hope and optimism for the future. Grounded in Christian values and a Biblical perspective, we strive to equip young ladies to make a positive impact in their classrooms, homes, communities, and personal lives.

If you have any questions, please email beementoringprogram@gmail.com or call 601-402-9799.
Mentee Full Name*
Preferred Name
Nickname
School & Grade *
Birth date *

MonthDayYear
Age *
Hobbies/ Favorite Color
T-Shirt Size*

Youth SYouth MYouth LAdult SAdult MAdult LAdult XLAdult 2XNone- Returning Mentee Only

Caregiver's Name*
Relationship to the mentee*
Address*
Primary Number*

Area CodePhone Number
Is it okay to send texts updates?*

YesNo
Caregiver's Email*
example@example.com
Other Caregiver/ Emergency Contact
Name
Relationship to Child
Other contact's phone

Area CodePhone Number
Pick Up Authorization
Please note that Only authorized cargivers/Emergency contacts may pick the child/ren up from Bee the Difference unless the caregiver has authorized to us stating otherwise. Picture I.D maybe asked before pick ups or drop offs.
MENTORING CLUB MEDICAL RELEASE FORM
PLEASE NOTE: This Medical Release Form will be used ONLY as necessary in the circumstances. Every reasonable effort will be made to notify a caregiver/Emergency contact listed above when these circumstances arise.
Preferred Hospital or Clinic*
Phone Number

Area CodePhone Number
Address
My child have the following allergies: Type N/A if None: *
My child is receiving medication or has a condition that may affect behavior or increase risks: Type N/A if None*
By signing below, I specifically authorize Bee the Difference Mentoring Program to provide for, and arrange in my place, necessary medical care.
MENTORING CLUB PARTICIPATION
I hereby give permission for my child to travel and participate in offsite events. *Advanced Notification will be given to parent for all off-site events.*

YESNO
I hereby give permission for my child to receive check-ins from a trusted mentor (via phone, text, social media etc.)*

YESNO
I hereby give permission for my child's picture to be used for Bee the Difference promotion and advertising, including, but not limited to, social media, brochures, newspaper or magazine articles, and website*

YESNO

PLEASE NOTE:

Mentee Participation

We understand that some mentees may be more reserved than others, and we will meet each mentee where they are. All mentees are encouraged to engage with their mentor at their comfort level and attend all in-person sessions unless we are notified in advance. Repeated absences or lack of engagement may result in removal from the program.

Transportation

Bee the Difference may transport mentees to and from offsite activities related to the program. Mentors or staff are not authorized to transport mentees outside of program-related activities or for one-on-one sessions. Parents are responsible for transporting their daughter to and from a mutually agreed-upon location for such activities after the director has been notified. Any violation of this policy may result in removal from the program.

Participation and Safety

Participation in any of our activities—especially in-person gatherings—carries some inherent risks. While Bee the Difference takes care to provide a safe environment and follows appropriate health and safety precautions, we cannot guarantee complete safety.

By allowing your daughter to participate, you acknowledge these risks and agree to release Bee the Difference, its staff, members, and volunteers from liability for any illness, injury, or other unforeseen circumstances that may occur during her participation.
Caregiver Signature*

Clear
Date*

MonthDayYear
Date
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Bee Mentee Application 2026 (Girls 13-18)

Pick Up Authorization

MENTORING CLUB MEDICAL RELEASE FORM

MENTORING CLUB PARTICIPATION