Stay in Touch w/Uplift Electronic Signature * By signing this electronically, I declare that I have read the text messaging consent agreement. I agree to receive promotional messages from Uplift Mentoring up to 4 Msgs/Month. This agreement isn't a condition of any purchase. I also agree to the terms of service and privacy policy set forth below this form. Msg & Data rates may apply. By submitting this form, I agree that my mobile information will not be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude my text messaging originator opt-in data and consent; this information will not be shared with any third parties, except for the necessary opt-in data required to facilitate the SMS service. Text STOP to opt-out. Text HELP for assistance. hello@upliftmentoring.org Thank you! 6th Grade Child's Name * First Name Last Name Parent/Guardian Name * First Name Last Name Relationship to Child * Parent/Guardian Phone * (###) ### #### Parent/Guardian Email * Photo/Media Release * Uplift Mentoring has my permission to use my or my child's photograph publicly to promote Uplift Mentoring. I understand that the images may be used in print publications, online publications, presentations, websites, and on social media. I also understand that no royalty, fee, or other compensation will become payable to me by reason of such use. Yes No Electronic Signature of Parent/Guardian * I understand that my child will participate in mentoring sessions with a trained high school student as part of the program and I agree to allow my child to participate in these activities. I agree to receive promotional messages from Uplift Mentoring up to 4 Msgs/Month. This agreement isn't a condition of any purchase. I also agree to the terms of service and privacy policy set forth below this form. Msg & Data rates may apply. By submitting this form, I agree that my mobile information will not be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude my text messaging originator opt-in data and consent; this information will not be shared with any third parties, except for the necessary opt-in data required to facilitate the SMS service. Text STOP to opt-out. Text HELP for assistance. hello@upliftmentoring.org Thank you!
