Parent Registration


Please read this carefully and check the boxes to agree before signing:

Emergency Contact Info

Emergency Contact Info: (to whom child may be released if guardian is unavailable)

Contact 1

Contact 2

Media Release

I, as the parent or guardian, hereby give Rise and Thrive and its employees, representatives, and authorized media organizations permission to publish, print,photograph, and record my child for use in photographs, or any other electronic,digital and printed media. This is with the understanding that Rise and Thrive and its representatives will utilize these photographs, and or media files for use in promotion of the organization; these files may be found on the organization website, social media, in-person presentations, and other presentations involving Rise and Thrive. I am also fully aware that I will not receive monetary compensation for my child’s participation. I further release and relieve Rise and Thrive, its CEOs and founders, employees, and other representatives from any liabilities, known or unknown, arising out of the use of this material. I certify that I have read the Media Consent and Release Liability statement and fully understand its terms and conditions. *

Policy Agreement

  • Mentees should be dependable and punctual. If you will be late or absent, please notify a mentor as soon as possible.
  • Mentees should fully participate in Rise and Thrive Inc. related activities and programming. We encourage mentees with cell phones to join the mentee-mentor GroupMe; it will be used as a quick communication tool.
  • Mentees should treat mentors, peers, and guest speakers with respect and kindness. Rise and Thrive Inc. has a zero-tolerance policy against bullying of any sort (including cyber bullying).
  • Mentees should limit cell phone usage during mentoring sessions. Mentees are encouraged to have their cell phones, but silenced or in their book bags during sessions.
  • Mentees should not utilize drugs or alcohol. Drug and alcohol use of any kind are strictly prohibited prior to or during any mentor-mentee activity. Rise and Thrive Inc. has a zero-tolerance policy towards the use of drugs and alcohol.
  • Mentees should not carry weapons of any kind when participating in any Rise and Thrive Inc. related programming. A dangerous weapon is a gun, knife, razor, karate stick, metal knuckles, or any other object that by the manner it is used or intended to be used is capable of inflicting bodily harm.
  • Mentees should refrain from wearing clothing with undergarments showing, excessive amounts of skin, inappropriate references, and/or vulgar and obscene imagery.
  • Mentees should have fun!

By typing your full name below you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form.
* I have voluntarily provided the above contact information and authorize RISE AND THRIVE and its representatives to contact any of the above on my behalf in the event of an emergency.