Mentoring Registration

YFC Canada

YFC is a national organization built on local chapters.

Registered Charity #106868847RR0001

YFC Northumberland

Registered Charity #132177296RR0001

Youth Info
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Gender*
Allergies or Medical Conditions?
Home Address
Address*
Street Address Address Line 2 City Province Postal Code
Parent/Guardian Info
1st Parent/Guardian Name*
First Last
1st Parent/Guardian Cell Phone*
1st Parent/Guardian Email*
Enter Email Confirm Email
2nd Parent/Guardian Name
First Last
2nd Parent/Guardian Cell Phone
2nd Parent/Guardian Email
Enter Email Confirm Email
Consents
PARTICIPATION*
Yes
I give permission for the youth in my care noted above, to attend and participate in this program set forth by Northumberland Youth Unlimited (YFC). I understand that Northumberland Youth Unlimited does not provide counselling services. Due to the nature of the Mentorship Program, I give permission for the youth in my care noted above, to meet with his/her mentor one-on-one in public locations.
ONLINE PARTICIPATION*
Yes
I give permission for the youth in my care noted above, to meet with his/her Mentor online via Zoom, or a similar application, when an in-person meeting is not permitted due to COVID-19 Public Health guidelines.
MEDICAL / PERSONAL HARM*
Yes
I give permission for the person(s) in charge to seek medical assistance for the youth in my care noted above, in the event of accident or injury. Furthermore, I do not hold Northumberland Youth Unlimited or any of its subsidiary programs responsible for any harm that may occur to the youth in my care noted above, as a result of his/her wilful participation in the program.
PHOTO / VIDEO (optional)
Yes
I do authorize Northumberland Youth Unlimited to take, use and own, in perpetuity; names, photographs or video/audio recordings of the youth in my care noted above, understanding that these may be used for public promotional purpose. Northumberland Youth Unlimited does not sell or give away any recorded materials or mailing list information.
TRANSPORTATION (optional)
Yes
If transportation is required, I give permission for the youth in my care noted above, to travel in a vehicle owned by Northumberland Youth Unlimited, or by its staff or volunteers, for the duration of the program. I understand that drivers and their vehicles are licensed and insured according to local, provincial and federal laws, insurance policies and NYU’s Policies & Procedures. Furthermore, I do not hold Northumberland Youth Unlimited responsible for any harm that may occur to the youth in my care noted above, as a result of his/her wilful participation in the transportation.
Signature*

Mentoring Registration

Youth Info

Home Address

Parent/Guardian Info

Consents