Rooted Mentors

Rooted is our afterschool ministry that serves children, grades 4-5, in the Conestoga Valley School District referred by a school counselor and approved by their parent/guardian. Each student is paired, one-on-one, with a mentor.

From September-May, Rooted meets afterschool on Tuesdays (3:30-5pm) at CVCCS and offers a fun, reliable, encouraging, healthy, and safe environment for students. Mentors offer friendship, and are a listening ear for their student mentee. No tutoring or homework.

Rooted includes:

A healthy snack.
An opportunity for each student to unwind from their day by talking to their mentor.
Fun games.
Bible study.
Group activities that foster teamwork.
Two times a year, CVCCS hosts family dinners as a way for families to get to know our mentors and staff.

Rooted Mentor Application:

An asterisk (*) appears next to all required fields.

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email Address*
Briefly describe your Christian testimony:*
Mentor Emergency Information:
For your safety and in the event of a medical emergency, please provide the following information-
1. Allergies:*
- Yes
- No
If yes, list below-
2. Emergency Contact & Phone:*
References:
Please list 2 references below- Personal and professional.
Reference #1:*
First Last
Phone*
Email
Reference #2:*
First Last
Phone*
Email
CVCCS Statement of Faith
We believe: There is One God who reveals as Father, Son, and Holy Spirit. The Bible is the inspired Word of God. Jesus Christ, The Son of God, came to earth as a baby, lived a sinless life, and willingly gave Himself to be crucified, dying as a sacrifice for the sins of man; He was buried and rose again. Salvation is offered to all who call upon the name of Jesus and believe in their heart that He is the Son of God making eternity with God possible. God’s Holy Spirit empowers the believer to live an overcoming life of service for Him and to our fellow man. (These were read and accepted into our bylaws at a meeting of the CVCCS board on August 26, 2010).
I have read & agree to the "CVCCS Statement of Faith" above.*
- I Agree.
Liability & Photo Release
By submitting this application, I agree that I will not hold CVCCS or its staff, interns, representatives, board of directors, or any fellow volunteers liable for accidents, injuries, or death to myself, my child, or any other person for whom I am lawful guardian, that may result from any volunteer activities by, arranged by, or participated in by CVCCS. Neither will I nor any person for whom I am lawful guardian, hold liable the persons who operate any equipment during volunteer activities for accidents, injury, or death.

Additionally, I consent to be photographed or videotaped and agree to allow CVCCS to use any photo or video to be used for future promotional purposes. I understand that I will receive no remuneration in the event that any photographs, images, actions, or voice are used in CVCCS brochures, advertisements, or visual presentations.

Furthermore, I understand the context in which my photo or video may appear in any CVCCS promotion/publication, and also consent for all purposes of reproduction or use of this photo or video in all manners. I release the designer(s), photographer(s), their nominees and designees of any personal and proprietary rights that I may have with, or in, the distribution or use of this photo reproduction.
I have read & agree to the "Liability & Photo Release" above.*
- I Agree.
If mentor applicant is below the age of 18 please include the name & contact info of parent/guardian:
Email
This field is for validation purposes and should be left unchanged.

Rooted Mentor Application:

Mentor Emergency Information:

References:

CVCCS Statement of Faith

Liability & Photo Release