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bdc building bridges mentorship

application

Event Participant information


Parental Permission and Release of Liability

Medical Emergency Authorization and Health Information I authorize the program coordinator(s) to take such action as seems appropriate to protect the health and physical well-being of the above participant. This authority extends to any physician(s) selected by the program coordinator(s) to perform medical procedures including examinations and tests necessary to preserve the health and physical well-being of the above named participant. All efforts will be made to contact the parent(s) or guardian(s) in case of emergency.

Medical Emergency Authorization and Health Information

I authorize the program coordinator(s) to take such action as seems appropriate to protect the health and physical well-being of the above participant. This authority extends to any physician(s) selected by the program coordinator(s) to perform medical procedures including examinations and tests necessary to preserve the health and physical well-being of the above named participant. All efforts will be made to contact the parent(s) or guardian(s) in case of emergency.

The following information is provided as an aid to the event coordinator(s) in dealing with the well-being of the participant. The participant has the following health conditions: (include allergies, handicaps, diabetes, pregnancy, asthma, medications needed, etc.).

Pick-Up Authorization

In addition to the parent/guardian(s)/emergency contact listed above, please list the names of any possible persons authorized to pick up the above referenced youth participant


Authorization for Self-Checkout (For Participants Ages 14 or Older)


Program participants will only be released at the scheduled program ending times, or times designated to the program by the parent/legal guardian. Please select from the check-out options listed below.

Youth Program Code of Conduct


The primary purpose of the Youth Program Code of Conduct is to ensure the safety and well-being of all participants at events and activities hosted by the BDC Youth Mentoring Program. It applies to all participants, including minors, their parents, and volunteers.
As a participant in this program, I will:
  1. Conduct myself in a courteous manner and treat members, parents, volunteers, staff, and others with respect. Appropriate language and behavior are expected at all times.
  2. Respect and adhere to the rules and guidelines of the program including all those specific to this event or activity.
  3. Uphold an individual’s right to dignity by supporting an environment of inclusion which welcomes involvement of participants from all backgrounds.
  4. Obey local, state and federal laws.

I understand if I fail to adhere to the above Code of Conduct, I will be subject to disciplinary action and potentially prohibited from attending and participating in this program.

I have been given a copy of the rules for this event and agree to abide by them. I have conveyed this information to the youth participant for which I am responsible

Media Policy and Release


The BDC Building Bridges Mentoring Program may promote programs and activities involving minors through various media. This includes, but is not limited to newsletters, brochures, and social media. In doing so, the names and photos of members may be included to help tell the story.