1. I agree to submit to an Illinois Criminal Background check.
2. I agree to spend a minimum of twelve hours with the assigned student over a period not less than three months and not more than nine months.
3. I agree to contact the program’s coordinators regarding any concerns or changes in the program.
4. I agree to give advance notice to the student and his/her parents or guardians if I will not be available for a meeting.
5. I agree to inform the program coordinators immediately if I must terminate a mentoring relationship with a student.
6. I understand that I am providing a voluntary service to the Mentoring Program at Hononegah Community High School District 207 and that the Mentoring Program coordinators at HCHS shall retain the discretion to terminate a mentoring relationship if necessary.
7. I agree to release and hold harmless the HCHS Gifted and Talented Program and its individual members from any and all claims I may have that result or arise from a termination of a mentoring relationship.
8. I realize that I am legally responsible for the HCHS student while he/she is under my care.
9. I agree to keep information regarding the student confidential.

Mentor’s Signature(s): __________________________________________________________

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Date: ________________________________________________________________________