This form must be completed in full and signed in order for youth to participate in the Champion Circle program, including the parent guardians consent form. Incomplete applications will not be accepted. Please print clearly or type. Every youth participating in this program must be willing to volunteer 5 hours a month in the community. Give A Day Foundation will provide those volunteer opportunities.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to enrollment, I understand that false or misleading information in my application or interview may result in the release of the youth named above. Participation in this program is a privilege and not a right. Both the parent/guardian and youth must understand this concept. If the rules and regulations are not followed the youth can be removed from the program at any time.

I, the parent or legal guardian for the youth named above, hereby give my permission for him to participate in the Champion Circle program. I fully understand that the program involves mentors, who shall be selected from the community and will be screened and trained, before participating in the program. I understand that I must participate in an orientation session in which the program will be explained. I understand that Champion Circle will provide ongoing monitoring of the mentoring activities. I give the Champion Circle program coordinator permission to obtain the youth named above, academic and attendance records from his school. I give permission for Champion Circle to utilize photographs of the youth named above, that will be taken during his involvement in the program and waive all rights of compensation. I understand that there is no fee involved, but the youth named above, must complete 5 community volunteer service hours every month.