Arts/Skill Share Program: Mentee Application Please enable JavaScript in your browser to complete this form.Arts/Skills Share Program: Mentee ApplicationParent/Guardian Names *Youth's Name *Birthdate *Age *Gender & PronounsAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent/Guardian Email *Emergency Contact Info (name, phone & relationship to child):Does this youth have any allergies or medical conditions?A Little About You - The StudentWhat would you like to get out of this experience?What kind of art of craft would you most like to explore in this program? (ex: drawing, wood-working, metal-working, painting, jewlery, etc.)What is your current schedule of after-school activities?Arts/Skills Mentor Program: Authorization for ServicesAs the parent/guardian of my child, I give permission for them to participate in The Funhouse Mentor Program. I understand that my participation in the program is completely voluntary and that I may terminate this authorization at any time. I understand that I can have a copy of this consent form upon request and may terminate this consent in writing at any time. *I AgreeArts/Skills Mentor Program: General Hold HarmlessIn the event of any injury, I authorize a qualified physician to examine the above-named child and to administer emergency care and to arrange for any consultation by a specialist that he/she/they deems necessary to ensure proper care of the injury. Every effort will be made to contact the parent/guardian to explain the nature of the problem prior to any treatment. In the event it becomes necessary for The Funhouse or my child's mentor to obtain emergency care for him/her/ them, neither the Mentor, the Funhouse Commons assumes any financial liability for expenses incurred because of accident, injury, illness, and/or unforeseen circumstances. I also understand during mentor program activities that accidents may happen that result in physical or emotional injury, paralysis or death as well as damage to property or to third parties. I agree to hold harmless The Funhouse Commons, Children's Discovery Foundation, its staff, its board of directors, and the mentor, should any such accident occur. *I AgreeParent/Guardian Signature *Clear SignatureDate *Ground Rules for Youth ParticipantsI agree to be on time for my meet-ups with my arts mentor. If I have to cancel or I will be late, I will let them know as soon as I can. *I AgreeI will work with my arts mentor to identify my goals, and arrive ready to work and learn when we meet. *I AgreeI understand that my mentor and I will be working to create pieces for an art show in April. I am working to create a finished product to share with the community. *I UnderstandI agree to tell a trusted adult if my mentor does anything that makes me feel uncomfortable. *I AgreeYouth Participant Signature *Clear SignatureDate *Ground Rules for Parent/GuardianI agree to make sure my child attends all of his/her/their scheduled meetings with the mentor. In the case of sickness, travel or any change of plans, we will notify the mentor as soon as possible. *I AgreeIf you feel the mentorship should end, please contact The Funhouse personnel immediately. The closing of a mentorship needs to be handled with care to avoid misunderstandings, hurt feelings and confusion. *I AgreePlease do not prevent your child from seeing their mentor as punishment. This relationship is intended to build skills in an art medium, and cultivate a helpful relationship with a caring adult; it is not intended to be a "reward" for good behavior. *I AgreePlease do not discuss your child with the arts mentor in the child's presence. If there is something the mentor should know, tell them with the child is out of range or contact them via email. *I AgreeTry to help your child be considerate of the mentor. Talk to your child casually after each visit to see how it went. If your child begins to be negative about the mentor and doesn't want to meet, try to determine why, and inform the Mentor Coordinator (Maddie Olson) as soon as possible. *I AgreeOccasionally try to let the mentor know that you appreciate their effots. *I AgreeForgive minor mistakes in judgement, should they occur. While our mentors are not trained professionals (although they are trained in mentoring), they are good people looking to create a positive impact on your child's life. *I AgreeArts mentoring activities may entail your child and their mentor to meet outside of The Funhouse, and/or at the mentor's private residence or studio. The mentor and parent/guardian will communicate about meeting location, and the parent/guardian will approve of any meeting location decision. The Funhouse does not participate in this decision and holds no responsibility for it. *I UnderstandBy signing this form, I understand and agree that photographs/videos taken of my child at The Funhouse may be used by The Funhouse for promoting programs, events, classes, in print, TV, social media or on the website. *I AgreeI Do Not AgreeParent/Guardian Signaure *Clear SignatureDate *Submit