Application – Project Arrow

Gender

Female Male Prefer not to disclose

Interest: (check for "yes", do not check for "no")

Are you interested in helping others? Are you interested in leadership skills? Do you want to be a student leader?

What school clubs, activities, or sports do you currently participate in?

Parent/LEGAL GUARDIAN information and Informed Consent:

Parent/LEGAL GUARDIAN email

Do you agree to allow use of photo and media of your child for program promotions and marketing?

yes no

Can names be used?

yes no

To collect and assess the positive impact of Project Arrow, do you agree to the collection of your student’s grades, attendance records, disciplinary actions, and grade promotion information? NO IDENTIFIERS WILL BE UTIILIZED; CONFIDENTIALITY WILL BE MAINTAINED.

yes no

By agreeing to allow your child to participate in the Project Arrow peer-to-peer mentoring program, (hereinafter “Program”) the undersigned custodial parent/guardian hereby submits that all above information is accurate and agrees as follows: The Program is intended to impact public school safety by conducting peer-to-peer mentoring, peer leadership, and family and peer life coaching to middle and high school students. THIS PROGRAM WILL COVER TOPICS SUCH AS leadership, resiliency, substance use disorder, opioids, bullying, depression, and concerns regarding potential school violence. Students may be screened for depression and/or other mental/behavioral health issues BUT NO IDENTIFIERS WILL BE UTILIZED; CONFIDENTIALITY WILL BE MAINTAINED. Students may be surveyed for Adverse Childhood Experiences that affect academic performance BUT NO IDENTIFIERS WILL BE UTILIZED; CONFIDENTIALITY WILL BE MAINTAINED. In signing this consent form, I affirm that I have read this document in its entirety and I understand what I have read. I shall indemnify and hold harmless Project Arrow and School trustees, officers, employees and agents from any liability, losses, costs, damages, claims or causes of action of any kind or nature associated with my child’s participation in the Program. I assume all responsibility for transportation to and from events and programs. I release Project Arrow and school employees from liability associated with transportation home.

We believe in students. We train them to become peer mentors and pass on what they’ve learned through Project-Arrow.

A life coaching program for students who want to become leaders.

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Student Participation Application Liability Waiver, Photo & Media Release