Dear Guardian, children who attended Royal Family KIDS Camp are eligible to apply for Utah Royal Kids Mentoring Club and experience more fun times with fellow camp kids and adult mentors (trained and cleared), for once-a-month, Saturday club meetings during the school year. There is no fee for participation (club includes club shirt and materials). We would ask you to bring your child to and from the club meetings, if possible, on the first Saturday morning of the month, from 10 am to 1 pm, Oct.-May. If you are unable to transport your child we will make every effort to provide transportation by a cleared, trained staff member, so they can attend.  Please complete this application and permission forms (medical release, transportation & activity permission, caregiver covenant, and pick up/ drop off authorization) which are required to safely interact with your child. The number of club mentors is limited so please make sure your child will be available for the monthly Saturday meetings. (If other activities will interfere with Saturday morning meetings, then perhaps club is not a good match for your child.) You will be contacted by the Mentoring Club Director to confirm acceptance to the club program. I understand that anyone with illness symptoms should stay home and skip meetings.

LIMITED ENROLLMENT AGREEMENT FOR CAREGIVERS: I understand that the number of children admitted is limited by the number of club mentors available and geography. As part of the process, I give permission to share my child’s camper application information (including social worker contact information) with club leaders.

This Medical 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’ Sandy GSLC Mentoring Club in any manner; it applies to all Mentoring Club activities, including both individual meetings with a Club mentor and group meetings, functions, and events (the “Activities”).
 
I hereby give permission for my child to attend and participate in the club activities.  I specifically authorize Royal Family KIDS’ Mentoring Club to provide for, and arrange in my place, necessary medical care.
 
I authorize the Royal Family KIDS’ Sandy GSLC 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 Sandy GSLC Mentoring Club Program.  
 
This Medical, Transportation and 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 programs in any manner; it applies to all Mentoring Club activities, including both individual meetings with a Royal Family KIDS Club Mentor 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 Sandy GSLC Mentoring Club to provide for, and arrange in my place, necessary medical care, as stated in the Medical Release Form.
 
I hereby also give my permission for my child to ride in any vehicle designated by the adult(s) in whose care my child has been entrusted while participating in the activities.
 
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 Club program, 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.
 
NO CHILD WILL BE ALLOWED TO PARTICIPATE IN ANY ROYAL FAMILY KIDS MENTORING CLUB ACTIVITIES UNLESS THIS FORM IS COMPLETED AND SIGNED FOR EACH CHILD.

I certify that I have read, understand, and agree to the provisions of these Medical, Activities and Transportation Permission Release Forms,

Royal Family KIDS Mentoring Club believes that parents and caregivers are our most important allies in helping children develop good values and achieve their full potential. Please review this Covenant, and sign below to indicate your agreement to work with Mentorin Club Leaders to create the best mentoring environment for your child.

My Commitment as Parent and/or Caregiver:
1. I understand that the Utah Royal Family KIDS Mentoring Club program runs through the school year and provides children group mentoring with cleared  mentors and trained staff on the first Saturday of each month, October through May. I will work with the club staff to ensure that my child is available for meetings, and to communicate with the club director concerning transportation needs, and to contact the director as soon as possible if plans must be changed due to illness or emergency.
2. I understand that URFK Club’s group mentoring program develops healthy relationships with positive role models, and is not a reward for good behavior. I agree not to withhold permission for outings with the club mentor or for club activities as punishment for my child’s misbehavior.
3. I understand that URFK club mentors are trained and prepared to spend their appointments with their URFK assigned Club Kid only. URFK club mentors are NOT allowed to take other non-URFK program children with him or her to URFK program events.
4.  I understand that the RFK club mentor may NOT leave the child at the home or any other location unless the adult caregiver OR the approved emergency contact (photo ID required) is present.
5. I understand that club meetings and URFK mentoring appointments are not permitted over the summer and URFK supervision will end on May 3, 2025.
 
                          FOR THE CHILDREN Sandy GSLC Chapter
                   COMMITMENT TO PARENTS AND CAREGIVERS
 
1. The club mentor(s) working with your child/ren will be drawn from the URK Camp network of volunteers and will have completed RFK Camp training, Mentoring Club  training, and full background checks.
2. The club mentor(s) will stay in touch with you regarding mentoring appointments and club events, and inform you of changes as needed.
3. The Mentoring Club Director will contact you during the year for feedback about the Club program, our volunteers, or your child’s participation. You may also contact the Mentoring Director at any time if you have questions, concerns or need information.

A photocopy of this executed form shall be valid as an original

• URK club mentors and club volunteers are NOT allowed to leave a child at his/herhome or other designated place unless the caregiver or other authorized adult ispresent.

• Only authorized adults may pick the child up from URK Mentoring activities.

• The club mentor will keep this form and a copy will be filed with the Mentoring Club Director.

I hereby give my permission for the adults (18+ YEARS OLD) listed below to serve as authorized emergency contacts for pick up and/or as adults with whom the RFK Mentoring volunteer may leave my child when bringing him/her back from a Mentoring Club meeting, event or mentoring club appointment. I understand that the Emergency Contact adult(s) named below must show a current picture I.D. to the RFK Mentor/Club volunteer before the volunteer may pick up or leave the child in their care. Any changes to this form must be submitted (with approved signature) to the Mentor for the Mentoring Director in writing.

ADULTS authorized to pick up my child, serve as emergency contact, and/or have child/ren left with him or her, including the PARENT/CAREGIVER/LEGAL GUARDIAN:

A photocopy of this executed form shall be valid as an original

FOR MORE INFORMATION CONTACT US via our website https://www.utahroyalkids.org/contact or email us directly at utahroyalkids@gmail.com