HIGH SCHOOL MENTORSHIP

HS Mentor Program

If you enjoy leading activities, teaching and spending time with younger students, join the L4G mentor program.

You work with a professional staff member to lead team building initiatives, model relationship building skills and facilitate small group discussions.

Benefits

Gain Experience Teaching and Coaching
Excellent Experience for your Resume & College Application
Earn 30-35 Community Service Hours (One Week in the Summer)
Strengthen your Leadership Skills while Helping Others
Receive Coaching & Mentoring from a Professional Staff Member

Requirements

HS Mentoring Program is Open to 8th -12th Grade Students
All HS Mentors are required to attend a High School Mentor Training held in May/June before camp begins
Commit to Coaching & Teaching One Week during Summer camp.

Make a Difference - Become a Mentor

Apply for High School Mentor Program

Mentor Information
Mentor's Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Date of Birth
MM slash DD slash YYYY
School Name
Current Grade In School (2022-2023)
Parent / Guardian Information
Parent / Guardian Name
First Last
Home/Main Phone Number
Email
Address
Street Address Address Line 2 City State ZIP Code
Additional Parent / Guardian Information
(optional)
Add Additional Parent/Guardian?
Name
First Last
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Health Information
Pediatrician’s Name
Phone
Family Medical/Hospital Insurance
Policy Number
Group Number
Allergies
Emergency Contact in Parent’s Absence
Name
First Last
Emergency Number
Alternate Phone Number
Relationship to Participant
Camp Selection*
- June 5-8
- June 12-15
- Both Weeks
You will be expected to arrive 15 minutes early and stay 15 minutes late for wrap up. We appreciate you volunteering your time to help Leadership 4Girls! You will earn approximately 30-35 hours of community service for each week of camp.

*There is a 2 hour training held the week before camp. Date to be determined. During this training you will learn expectations for your role as a mentor. You will also participate in team-builders, icebreakers and small group discussion skills.

If you have any questions, please call 321-946-1629 or text Cindy at or Email at cindy@leadership4girls.org
Our Policies
Permission/Waiver/Release
I, the undersigned, as the parent or legal guardian of the participant, give permission for her to participate in activities offered by Leadership 4Girls. I know of no medical, physical, mental or emotional condition that would hinder or prevent her participation in the Leadership 4Girls program. I waive any claim of liability against, and agree to hold harmless Leadership 4Girls and any other officer, agent and/or employee thereof from any claim of injury to participant arising out of or in any way connected with any class or activity offered by Leadership 4Girls.

Permission to Provide Necessary Treatment or Emergency Care
If I cannot be reached in a medical emergency, I give permission to the medical care provider(s) selected by Leadership 4Girls to secure and administer all necessary treatment, including hospitalization, for the participant.

Photography , Video Recording and Program Evaluation
Any picture, recordings, video footage, any images moving or still and/or writings will belong to Leadership 4Grils and may be used for advertising and promotion. I understand that Leadership 4 Girls conducts evaluations to assess the quality of programs. I give permission for my daughter to be part of this program evaluation. I also understand that the information collected about my daughter will be kept confidential and her name will not be associated with the results.

Program Evaluation
I understand that Leadership 4 Girls conducts evaluations to assess the quality of programs. I give permission for my daughter to be part of this program evaluation. I also understand that the information collected about my daughter will be kept confidential and her name will not be associated with the results.

I have read, understand and agree with the Permission/Waiver/Release, Consent for Emergency Medical Treatment, Photo and Video Recording, Program Evaluation and Refunds and Cancellation policies.
Signature
Consent
I agree to the privacy policy.

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MS Mentor in Training Program (MIT)

Requirements

Middle School Mentor in Training (MIT) program is open to students entering 7th or 8^th grade.
All MIT candidates are required to attend a Mentor Training held at the beginning of summer (2-3 hours).
Call MIT candidates must commit to working with a high school mentor one week during the summer.
Commit to one week of camp running Monday – Thursday 8:15-3:45 p.m.
Complete Registration on registration page and select the week to participate. MIT fees are half the price of campers. Scholarships are available. Email Cindy@ leadership4girls if you would like scholarship information.

Make a Difference - Become a Mentor

Apply for Middle School Mentor Program

Mentor Information
Mentor's Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Date of Birth
MM slash DD slash YYYY
School Name
Current Grade In School (2022-2023)
Parent / Guardian Information
Parent / Guardian Name
First Last
Home/Main Phone Number
Email
Address
Street Address Address Line 2 City State ZIP Code
Additional Parent / Guardian Information
(optional)
Add Additional Parent/Guardian?
Name
First Last
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Health Information
Pediatrician’s Name
Phone
Family Medical/Hospital Insurance
Policy Number
Group Number
Allergies
Emergency Contact in Parent’s Absence
Name
First Last
Emergency Number
Alternate Phone Number
Relationship to Participant
Camp Selection*
- June 5-8
- June 12-15
- Both Weeks
You will be expected to arrive 15 minutes early and stay 15 minutes late for wrap up. We appreciate you volunteering your time to help Leadership 4Girls! You will earn approximately 30-35 hours of community service for each week of camp.

*There is a 2 hour training held the week before camp. Date to be determined. During this training you will learn expectations for your role as a mentor. You will also participate in team-builders, icebreakers and small group discussion skills.

If you have any questions, please call 321-946-1629 or text Cindy at or Email at cindy@leadership4girls.org
Our Policies
Permission/Waiver/Release
I, the undersigned, as the parent or legal guardian of the participant, give permission for her to participate in activities offered by Leadership 4Girls. I know of no medical, physical, mental or emotional condition that would hinder or prevent her participation in the Leadership 4Girls program. I waive any claim of liability against, and agree to hold harmless Leadership 4Girls and any other officer, agent and/or employee thereof from any claim of injury to participant arising out of or in any way connected with any class or activity offered by Leadership 4Girls.

Permission to Provide Necessary Treatment or Emergency Care
If I cannot be reached in a medical emergency, I give permission to the medical care provider(s) selected by Leadership 4Girls to secure and administer all necessary treatment, including hospitalization, for the participant.

Photography , Video Recording and Program Evaluation
Any picture, recordings, video footage, any images moving or still and/or writings will belong to Leadership 4Grils and may be used for advertising and promotion. I understand that Leadership 4 Girls conducts evaluations to assess the quality of programs. I give permission for my daughter to be part of this program evaluation. I also understand that the information collected about my daughter will be kept confidential and her name will not be associated with the results.

Program Evaluation
I understand that Leadership 4 Girls conducts evaluations to assess the quality of programs. I give permission for my daughter to be part of this program evaluation. I also understand that the information collected about my daughter will be kept confidential and her name will not be associated with the results.

I have read, understand and agree with the Permission/Waiver/Release, Consent for Emergency Medical Treatment, Photo and Video Recording, Program Evaluation and Refunds and Cancellation policies.
Signature
Consent
I agree to the privacy policy.
Middle School Mentor Registration
Price:
Total Registration Fee
$0.00

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NEW ON-LINE REGISTRATION

To begin the registration process, click on the purple "Register for.." button above this box.

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