MENTORSHIP PROGRAMS

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.

Requirements

HS Mentor Program is open to students currently in 9th-12th grade.
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.

High School Mentor Application

"*" indicates required fields

Mentor Information

Mentor's Name

First Last

Date of Birth

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Phone

School Name

Current Grade In School

Parent / Guardian Information

Parent / Guardian Name

First Last

Home/Main Phone Number

Address

Street Address Address Line 2 City State ZIP Code

Additional Parent / Guardian Information

(optional)

Add Additional Parent/Guardian?

Name

First Last

Phone

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

Relationship to Participant

Emergency Number

Alternate Phone Number

Camp Selection*

June 3 - 7

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 MANDATORY orientation held the week before camp on May 21, 2024 4-6 p.m. During this orientation mentors will learn expectations, roles and responsibilities and connect with other mentors and L4G staff. .

If you have any questions, please call 321-946-1629 or text Cindy at or Email at cindy@leadership4girls.org

CPR/Babysitter Certification Option ($120.00)

I DO want to participate in the CPR/Babysitter certification at camp (This option will include a $120 cost for the certification and will take place two hours a day four days of camp. All other hours will be in the role of mentor earning community service hours).

I DO NOT want to participate in CPR/Babysitting certification (no charge)

Certification will be two hours during camp on Monday-Thursday. Friday will be a regular camp day.

CPR/Babysitter Certification

Price:

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.

Total Registration Fee

Mentor In Training (MIT) Program

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

Requirements

Middle School Mentor in Training (MIT) program is open to students currently in 6th - 8^th grade.
All MIT candidates are required to attend a Mentor Training held at the beginning of summer (2-3 hours).
All MIT candidates must commit to working with a high school mentor one week during the summer.
Commit to one week of camp running Monday – Friday 8:15-3:45 p.m.

Middle School Mentor Application

"*" indicates required fields

Mentor Information

Mentor's Name

First Last

Date of Birth

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State ZIP Code

Phone

School Name

Current Grade In School

Parent / Guardian Information

Parent / Guardian Name

First Last

Home/Main Phone Number

Address

Street Address Address Line 2 City State ZIP Code

Additional Parent / Guardian Information

(optional)

Add Additional Parent/Guardian?

Name

First Last

Phone

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

Relationship to Participant

Emergency Number

Alternate Phone Number

Camp Selection*

June 3 - 7

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!

*There is a MANDATORY orientation held the week before camp on May 21, 2024 4-6 p.m. During this orientation mentors will learn expectations, roles and responsibilities and connect with other mentors and L4G staff.

If you have any questions, please call 321-946-1629 or text Cindy at or Email at cindy@leadership4girls.org

Add CPR/Babysitter Certification Option

I do not want to participate in CPR/Babysitter Certification at camp.

I do want to participate in the CPR/Babysitter certification at camp (trainee will be 12 years of age as of June 3, 2024)

Middle School Mentor in Training is or will be 12 years of age as of June 3, 2024. Minimum requirement for CPR/Babysitter certification is 12 years old.

Certification will be two hours during camp on Monday-Thursday. Friday will be a regular camp day
If you have any questions, please call 321-946-1629 or text Cindy at or Email at cindy@leadership4girls.org

Our Policies

Signature

Consent

I agree to the privacy policy.

Middle School Mentor Registration

Price:

Total Registration Fee

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