Cincinnati Youth Collaborative

Cincinnati Youth Collaborative Permission Slip

I give permission for my child to participate in the Cincinnati Youth Collaborative mentoring and college access programs. I understand that all Mentors are volunteers, not school or CYC employees, and that mentoring activities with my child are intended to help him/her graduate from high school with the knowledge, skills, attitudes and behavior necessary to participate fully and responsibly in society.

I give permission for teachers and counselors in Cincinnati Public Schools and other CYC Partner schools to share information with the mentor(s), and CYC coordinator(s) about my child, including electronic (Power School) and physical scholastic/attendance records, as well as, any health or medical problems my child may have. I give CYC permission to share contact information with collaborative mentoring partners on behalf of my child.

I understand that mentoring may include virtual or in person activities. The availability of in person activities will be based on the recommendations of local, state, and/or other government and health official’s, the permission of the parent and/or legal guardian, and the comfortability of the volunteer. CYC’s Mentoring Program follows the current guidelines of our local health officials and defers the ultimate decision making power to that of the parent and/or legal guardian. Any in person activities taking place must have the consent of the parent and follow the necessary precautions recommended by the local government and health officials at that time.

CYC’s Virtual Mentoring Program takes place primarily on our Mentoring Assistance Platform (M.A.P.), which is a monitored online system where mentors can interact with mentee’s via video or chat. This program is designed to assist the mentee in their academic and social and emotional growth.

In the event that in person activities is allowed, my permission is required for my child to go to mentoring activities in a private car driven by a mentor, in a bus, public transportation vehicle or in a vehicle driven by a school employee.

I grant permission for myself/my child to be photographed, recorded, or videotaped for CYC promotional and educational materials. I understand that this photograph, speech, or video may appear in various publications or marketing and media outlets for recruitment of volunteers. I also give permission for this material to appear on the CYC social media pages and website ( I understand that this material may appear on television or other media for related promotional purposes, as well as in print or online for partner organizations. I give permission for my child to participate in program evaluation surveys and understand I may be required to complete occasional program evaluations.

I agree to indemnify and hold harmless the Cincinnati Youth Collaborative, its mentors, partner schools, Cincinnati Public Schools and their agents, employees and/or family members from any and all injury or damage arising from my child's participation or non-participation in the mentoring program. I support the mentoring program, and will encourage my child's participation. I understand that if my child does not adhere to the guidelines of the CYC Mentoring Program, he/she may be removed from the program.

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Signature Certificate
Document name: Cincinnati Youth Collaborative Permission Slip
lock iconUnique Document ID: 5d7bc958021b3c27b8e53463a8042d117dd693c7
Timestamp Audit
July 10, 2019 12:42 pm EDTCincinnati Youth Collaborative Permission Slip Uploaded by Chris Lipscombe - IP
June 2, 2020 1:32 pm EDTCheri Jordan - added by Chris Lipscombe - as a CC'd Recipient Ip:
July 17, 2020 1:03 pm EDTCheri Jordan - added by Chris Lipscombe - as a CC'd Recipient Ip:
September 21, 2020 3:21 pm EDTCheri Jordan - added by Chris Lipscombe - as a CC'd Recipient Ip:
January 18, 2022 1:44 pm EDTCrystal Smith - added by Chris Lipscombe - as a CC'd Recipient Ip:
October 25, 2023 3:46 pm EDTCrystal Smith - added by Chris Lipscombe - as a CC'd Recipient Ip: