STUDENT APPLICATIO N PLEASE EMAIL COMPLETED FORM TO mentoring@caymanchamber.ky
STUDENT INFORMATION (please type) Name: ____________________________________________School & Grade/Year: ______________________________________ P.O. Box #:______________ KY1- ____________ Email Address: _____________________________________________________ Date of Birth (day, month, year): _____________________________________________ Gender (male or female): ____________ Home phone number: _________________ Cell phone number: _________________ Nationality: _________________________ Career Interests: ____________________________________________________________________________________________ Interests/Hobbies: ___________________________________________________________________________________________ I understand that in the workplace, I may become privy to confidential information of a personal or business nature and I promise not to divulge the information to any other parties and respect the trust placed in me through my placement in this Programme. I also understand that any information of any illegal nature that I divulge may be reported to the appropriate authorities. Student Signature: __________________________________________________
Date: ________________________________
PARENT/GUARDIAN INFORMATION (please print clearly) Name: ________________________________________________________ Relationship to child: __________________________ P.O. Box #:______________ KY1- ____________ Email Address: _____________________________________________________ Physical Address: ____________________________________________________________________________________________ Home Phone: ______________________ Work Phone: ____________________ Cell Phone: _____________________________ I understand that my child has expressed an interest in Mentoring Cayman and I support his/her application and give my permission for him/her to participate. I know that this involves one day per month, during the school year, in which he/she will be placed with his/her Mentor and approve of this commitment. I will ensure adequate transportation is provided for him/her to and from the Mentor’s workplace on the appropriate dates during the school year. I will also provide feedback to the Programme during the school year and at the conclusion of the Programme. Additionally, I will contact the Chamber of Commerce at the numbers listed below immediately if any issues arise or any problems develop. I have read the above guidelines, which outline my responsibility as the parent/guardian and agree to abide by them as long as the student is a participant. Parent/Guarding Signature: _______________________________________________ Date: ______________________________ P.O. Box 1000, Grand Cayman KY1-1102, Cayman Islands Tel: (345) 949-8090 Fax: (345) 949-0220 Website: www.caymanchamber.ky
STUDENT APPLICATIO N THE STUDENT IS ASKED TO TYPE TWO PARAGRAPHS EXPLAINING HIS/HER EXPECTION OF THE PROGRAMME.
PLEASE EMAIL COMPLETED FORM TO programmes@caymanchamber.ky P.O. Box 1000, Grand Cayman KY1-1102, Cayman Islands Tel: (345) 949-8090 Fax: (345) 949-0220 Website: www.caymanchamber.ky
PARENT RELEASE FORM I agree to allow my son/daughter or child ___________________________for whom I am the guardian of to go on and/or participate in the following activities: OFF SITE WORKPLACE VISITS/LUNCHES WITH HIS/HER MENTOR with THE MENTORING CAYMAN PROGRAMME (hereafter the “Organisation”). I understand these activities may take place from the commencement of the first workplace visit through the end of the programme. I understand that all rules of conduct and standards of behaviour, as deemed by the Organisation will apply to these activities and I have discussed these with my child. I further understand that I must assume all responsibility and liability for my child while traveling to, from, and during these activities. With this knowledge, I freely assume this responsibility and liability. I further understand that the Organisation is not responsible for any damages or accidents that may result from my child’s actions. To the greatest extent possible, I release the Organisation and all those acting on their behalf, from all liability for damages to or caused by my child as a result of this trip/activity and I agree to indemnify them for any such damages. I hereby give my consent for my child to receive emergency medical care during these activities. I hereby also give my consent for photographs of my child to be taken and released to the media. Printed name of parent/Guardian: _____________________________________________ Signature of parent/Guardian: ________________________________________________ Date:____________________________________________________________________
P.O. Box 1000, Grand Cayman KY1-1102, Cayman Islands Tel: (345) 949-8090, Fax: (345) 949-0220