Parent/Guardian Consent Form

Parent/Guardian Name

First Name

Last Name

Parent Email Address

Phone Number

(###)

###

####

Child's Name

Child's Age

City/State

I authorize my child to participate in We "R" Listening's E-Mentoring Program

Parent/Guardian

I understand that my child will be participating in virtual E-mentoring sessions with the assigned Mentor for one hour per week

Parent/Guardian

I will be fully committed to supporting my child while in We "R" Listening's E-mentoring program

All of my questions/concerns were fully addressed regarding We "R" Listening's E-mentoring program and how it relates to my child

I have read and fully understand We "R" Listening's Liability & User Policy located on We "R" Listening's website

Parent/Guardian

I have read and fully understand We "R" Listening's Confidentiality Policy located on We "R" Listening's website

By submitting this form, I certify that I am the parent or legal guardian of the child listed on this form and I have the right to authorize participation in We "R" Listening's E-mentoring program and my submission of this document serves as my e-signature.

Date

YYYY

ABOUT WE "R" LISTENING®

We R Listening Inc is a 501(c)(3) non-profit organization whose mission is to mentor and unlock the potential in every young girl we mentor. We accomplish this by building their confidence & self-esteem and help them to develop a positive perception of themselves so they can improve in their interpersonal relationships, excel in their academics, and make the best life decisions.

Parent/Guardian Consent Form

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ABOUT WE "R" LISTENING®

Contact Us:

Telephone: (347) 337-2926 Email: Info@werlistening.org