Mentorship Matter Registration Form (2026-2027)

Mentorship Matter

Cohort Registration Form
Date: September 2026 to June 2027
Location: 904 19 Street NE
Calgary, Albeta
Our team at Cornerstone Youth Centre (CYC) have been reevaluating our mission as an agency. In the past, Cornerstone aimed for high registration and attendance at the centre in hopes to help as many youth as possible. When we reopened our centre after the first COVID-19 lockdown, we naturally saw lower numbers of youth than pre-pandemic. Although not what we were used to, we began to realize that we had a greater impact on youth with smaller numbers. Therefore, CYC has decided to adjust the structure of our centre slightly, by focusing on a smaller cohort of youth.

The Cohort Program is to intentionally provide youth with programs and set goals to help build on their future life skills. By focusing on being supportive, engaging in meaningful programs,

Cornerstone Youth Centre's Cohort Program is changing. We will be implementing a set schedule where youth will be divided by grades. CYC believes this will help create programs based on their developmental needs to fit the youth in their respective groups. Group A will be on Monday, Wednesday. Group B will be on Tuesday and Thursday. Friday will be open to ALL cohort youth. Youth must agree to attend Cornerstone as well as participate programs at least 8 times a month/twice a week minimum (programs are on Monday, Tuesday, Wednesday, and Thursday. Friday are our free days, and a time to catch up on one-on-one's. However, one-on-ones can be any day you like). We belive consistency teaches stability and structure which youth need to thrive.

Youth must also attend one-on-one weekly H.A.R.D (Heartfelt, Animated, Required, Difficult) goal setting sessions with their mentor. Mentor will support youth establish goals as they will keep them accoutable in meeting goals. In the event that youth are not able to attend Cornerstone, they are enouraged to reach out via discord or phone to let a staff member know. An accumulation of unexplained absences may result in removal from the cohort.
Youth Personal Information
Youth Name

First NameLast Name
Age
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Youths Phone Number

Area CodePhone Number
Youths Email
example@example.com
Primary Address

Street Address

Street Address Line 2 (Complete if live in two parent's home)

CityState / Province

Postal / Zip Code
Primary Community
ie: Mayland, Vista, Dover
School Name
Grade
Group
Does your child have any medical conditions we need to be aware of?
Medical Conditions
If Yes, please elaborate
We believe eating a hot meal together at the dinner table promote good youth development. Therefore, Cornerstone provides hot meals everyday at the centre and will introduce food that are from different cultures. Does your child have any allergies that we need to be aware of?
Allergies
If Yes, please elaborate
Parent/Guardian Details
Parent/Guardian Name

First NameLast NameRelationship (ie: Mother, Father, Grandma, Grandpa)
Phone Number

Work, Home, CellphonePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Parent/Guardian Name

First NameLast NameRelationship (ie: Mother, Father Grandma, Grandpa)
Phone Number

Work, Home, CellphonePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Emergency Contact Details

If parent/guardian cannot be reached.
Contact Name

First NameLast Name
Phone Number

Area CodePhone Number
Off Campus Consent
Cornerstone believes that youth doing programs in the community will build stronger community connection. Youth will then gain a sense of belonging and help develop their social skills. Therefore, Cornerstone will have programs that involve your child being taken off site.

By signing this I am aware that my youth will be taken offsite for programs. These will happen throughout the semester to give youth the opportunity to build on life skills. I give authorization for my child to engage in the activities outside and in the surrounding area.

As a parent/guardian of _____________________, registered at Cornerstone Youth Centre (CYC), I release Cornerstone as well as the directors, officers, agents, members, employees, participants, volunteers, sponsors, owners/operators of the facility, and representatives, from any and all actions, causes of action, claims or demands whatsoever from any, but not limited to, personal injury, including death, loss or damage property arising in any way whatsoever from my child's participation in activities and programs offered by CYC at the centre while attending events or engaging in offsite activities with empoyees and/or volunteers of Cornerstone.
Parent/Guardian Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Respectful Behaviour Policy
I understand that the Cornerstone Youth Centre is committed to providing a safe and respectful environment to all attendees, and that I/my child must follow the rules of respect for myself and others while attending Cornerstone. I also understand that failure to follow such rules will result in my/my child's removal from the program on a temporary or permanent basis, as the Cornerstone staff sees fit. I also understand that the staff of Cornerstone has fully discretion in making decisions about temporary or permanent removal from the program for the safety and sercurity of myself/my child and others. The Respectful Behaviour Policy also include when we are away/off campus from the centre.

Youth in the centre are expected to participate in any program or activity that Cornerstone has planned for the day. Youth who are not willing to participate and meet the expectation that day they will be asked to sign out and try again tomorrow or can be removed from the cohort program.
Parent/Guardian Signature
Youth's Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Phone Policy
As of July 04, 2023 Cornerstone has implemented a "Cellphone Free Policy" within the centre. When youth enter the centre they will be asked to give their phone to a staff member to put away in a caddy, they will only receive it back from staff once they sign out of the centre. Phones will be kept in a locked office. Parents or guardians who need to contact their youth are invited to call the centre at 403-276-5360. This policy was introduced due to the high usage of cell phones in the centre and we believe social interaction will help support youth emotional intelligence. Below is a link to research supporting our stance on cellphone usage in the centre and its effects on a youths brain and development.

Social Media and Youth Mental Health
Youth's Signature

Questionaire

This is to be done by the youth only!
How did you find out about Cornerstone Youth Centre?
What skills are you trying to build while at Cornerstone? (Minimum 2)
Why do you want to be part of Cornerstone Youth Centre's Cohort Program?
What does commitment and consistency mean to you?
On a scale of 1-10 how much do you need this program? 1 being not at all and 10 being a high need. Please explain why.
What is your biggest dream? How can Cornerstone Youth Centre help you with this dream?
Are there times you feel anxious or depressed? If yes, explain why.
Finish this sentence. I am ____________________________________.

Guardian-Mentor Meetings
Something new we want to integerate into Cornerstone is having Guardian-Mentor meetings! Cornerstone wants to be more intentional in creating relationships with the parents and gaurdians of the youth at the centre. These meetings can be lighthearted in sharing the youths goals, what they've been up to, and how they're doing in general at the centre. However, it can be a moment where we can also share challenges, and work together to be the best support for your youth.

These meetings will take place at least twice per semester. However, if you would like to have additional meetings throughout the semester, that is completely okay as well! There will not be a set week for these meetings. Instead, mentors will do their best to work around your schedule and find a time that works best for you.

There will ideally be a meeting every second month:

Fall Semester: October and December
Winter Semester: February, April, and June

At the beginning of each of these months, we will send your youth home with a letter reminding you to contact their mentor and arrange a meeting time. The mentor you will be meeting with will depend on which mentor your youth has been matched with for that semester.

By signing this, you acknowledge that you will partake in the Gaurdian-Mentor Meetings throughout the semester.
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Signature

Departure Follow-Ups
When youth graduate and exit the centre, Cornerstone remains committed to supporting them beyond their time in our programs. Cornerstone will follow up with your youth 3 times after they graduate with a survey. Once at the start of High School, once in the middle of High School, and once 1 year near the end of their Highschool, after graduating from Cornerstone. During these check-ins, we see how they are doing, how their experience at Cornerstone has continued to support them in their current stage of life, and whether there are any challenges, goals, or needs they would like support with. These follow-ups provide an opportunity to stay connected, celebrate their progress, and offer additional resources, guidance, or referrals when needed as they continue moving forward.

After the 1 year follow-up, the youth and mentor will decide together if the surveys are still needed and to be continued, or if they are no longer needed, and we pause the follow-ups.

By signing this, I am giving consent for Cornerstone staff to do follow ups with myself/my youth once they have graduated from the Cornerstone Program.
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Signature
Youth Signature

Acknowledgment, Authorization, and Photo Consent
I would like to register my child for this school year at Cornerstone Youth Centre. I give authorization to engage in the programs in and outside of Cornerstone Youth Centre.

I am aware that photographs and digital recordings may be taken at the Centre and outside of the Centre, during programs, field trips and may be used for promotion of Cornerstone Youth Centre in various media forms, including website, Facebook and Instagram. I consent taking photography and the use of of it and understand that I can revoke my consent at any time.

I authorized Cornerstone Youth Centre to apply judgement in regards to medical assistance in the event of an injury (scraps and cut from playing ouside or the basketball court) if they are unable to contact the parent/guardian. I allow them to apply first aid and treatment as necessary.

I release Cornerstone Youth Centre and any of its staff and volunteers for any responsibility in case of accident, illness, or injury during the youth's enrollment.

I have carefully read and understand that by signing this CONSENT and RELEASE OF LIABILITY that I am giving up certain legal rights which I may have, including the rights to sue the above mentioned organizations, their employees and volunteers. I have carefully read this Consent and Release and understand it, and signing it voluntarily and with full knowledge of its significant. This CONSENT and RELEASE OF LIABILITY shall be binding upon me and my heirs, executors, administrators, and personal representatives.
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Signature
CORNERSTONE YOUTH CENTRE
904 19 Street NE, Calgary, AB, T2E 4X7
programs@cyccalgary.com - www.cornerstoneyouthcentre.com
Should be Empty:

Mentorship Matter

Youth Personal Information

Parent/Guardian Details

Emergency Contact Details

Off Campus Consent

Respectful Behaviour Policy

Phone Policy

Questionaire

Guardian-Mentor Meetings

Departure Follow-Ups

Acknowledgment, Authorization, and Photo Consent