Non-Discrimination Statement

Non-Discrimination Statement and Right to Refuse Service Stronger Than My Father, Inc. is committed to providing an inclusive and welcoming environment for all participants. We do not discriminate on the basis of race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, marital status, or military status in any of our activities or operations. This includes the enrollment and participation in our programs, as well as the selection of mentors, volunteers, and vendors.

While we strive to serve all eligible individuals, Stronger Than My Father, Inc. reserves the right to refuse service to any participant who does not meet our program criteria or whose behavior is deemed detrimental to the safety and well-being of others. Our program criteria are designed to ensure that all participants benefit from a supportive and structured environment conducive to personal growth and development.

Youth's First Name

Parent/Caregiver's Legal Last Nam

Current Age

Grade In August

Name Of School Attending

How would you describe the youth, in terms of participation in events, activities, or sports?

Please Select

Which activities does the youth enjoy more?

Please Select

Does the youth have any allergies?

Please Select

Pertinent Medical History

N/A If Not Applicable

Is the youth taking any medications?

Please Select

Are there any special dietary needs?

Please Select

Are there any physical restrictions?

Please Select

If yes, please specify:

Does your youth have any medical or mental health conditions that might affect their participation in activities with a Mentor?

Please Select

Has your youth had any contact with juvenile court, police or probation staff?

Please Select

Has your youth been truant at school?

Please Select

Has your youth witnessed or been the victim of violence?

Please Select

Guardian's Relationship to Youth

Please Select

Is there a person who shares custody of this youth?

Please Select

Are you the child's biological parent?

Please Select

Has a significant adult figure who is in jail or prison?

Please Select

Is/has been a victim of crime?

Please Select

Parent/Caregiver's Legal First Name

DOB

Youth's Last name

Mailing County

Please check here if your mailing address is different from your residential address:

Work Phone

Best Time to Call

Personal Email

Contact Preference

Place of Employment

Type NA if unemployed

What is the primary reason for you wanting your youth to have a Mentor?

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Parent/Caregiver's Gender Identity

Please Select

Parent/Caregiver's Preferred Name

Annual Household Income

Is the youth eligible to receive free/reduced lunch?

Does your family receive income assistance?

Do you anticipate any significant life changes over the next year, or have you had any in the past year?

How did you hear about Stronger Sons Mentorship Program

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Emergency Contact Relationship to Youth

If Other In Above Question Specify Emergency Contact Relationship

Mobile Phone

Please Upload The PDF Release Form Here When Submitting This Application

Non-Discrimination Statement

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