Path 2 Success Brotherhood

Mentee Application

Complete this form to apply for a young man to join Path 2 Success Brotherhood.

Developing disciplined leaders who know they matter.

Applicant Information

Applicant Name

Date of BirthAgeGrade

School Address

Parent / Guardian Information

Parent/Guardian Name

PhoneEmail

Emergency Medical Information

Emergency Contact

RelationshipPhone

Allergies Medical Conditions

Interests & Program Fit

What are the young man’s interests, hobbies, or sports? Why would you like him to join Path 2 Success Brotherhood?

Permissions & Agreements

I grant permission for Path 2 Success Brotherhood to use photos, videos, and recordings for program promotion, social media, website content, and community outreach. I authorize my child to participate in approved program transportation activities when supervised by authorized staff or volunteers. I understand mentees are expected to show respect, honesty, accountability, good sportsmanship, and positive behavior. I agree to support my child’s participation, maintain communication with program leadership, and encourage attendance. I acknowledge participation involves normal risks associated with youth activities and release Path 2 Success Brotherhood, its staff, volunteers, and partners from liability except where prohibited by law.

Final Authorization

Parent/Guardian Electronic Signature Mentee Electronic Signature Date

By submitting this form, you agree that Path 2 Success Brotherhood may contact you using the information provided.