We appreciate your interest in becoming a mentor. The information in this application will be kept confidential.

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Mentee Information

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Parent/ Guardian Contact Information

OurGEMS and OurGents are mentoring programs available to students 9 years to 21 years of age.
Research has proven that the mentoring relationship has great benefits to your student’s academic, social
and emotional well-being. All mentors are thoroughly screened and must complete a background check
for your child’s safety. Mentors receive training to lay the foundation for a successful mentoring
relationship as well as clarify roles, boundaries, expectations, and safety issues.

We are required to report any minor (under 18 years of age), who is currently endangered by abuse or
neglect, and to report if children are suspected of being a danger to themselves or others. OurGEMS and
OurGents is not responsible for any accident or loss of property incurred during the mentoring
relationship. OurGEMS and OurGents’ program staff, mentor, or other representatives, both collectively
and individually, are released of any fault or liability of any kind or nature incurred during the mentoring

In permitting your child to participate in the OurGEMS and OurGents program, you understand that
OurGEMS and OurGents is authorized to release or exchange any relevant information with its partners
solely for reporting purposes. We request your permission for your child’s participation. Your child’s
participation is completely voluntary.

By signing below, I attest to the truthfulness of all information listed on this application and agree to
all of the above terms and conditions.

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