Mentee Full Name: *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you find out about Buckets of Rain? *

School Counselor

School Presentation

Teacher

Current Buckets of Rain student

Internet search

Other after school or mentorship program

Other

Parent / Guardian 1 Phone Number: *

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Parent / Guardian 2 Phone Number:

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Commitments

I understand that I am expected to attend all mentoring sessions, small group sessions, and large group sessions.

I understand that I am to inform my mentor if I will not be able to attend a session due to an illness or emergency.

I understand that I am expected to complete any session pre-work or post-work provided to me by my mentor.

I have informed my parent / guardian about these requirements for participation in Buckets of Rain.

By checking this box, you agree that you have read and understood the Privacy Policy of Buckets of Rain and you agree to be bound by it. You also confirm that all the information submitted is honest, correct, complete and has been written only by you.