CONNECTIONS PROGRAM MATCH MEETING SUMMARY

Child/Youth _____________________ Adult Volunteer __________________ Parent/Guardian ____________________ Date of Meeting _____________________

General Description of the meeting content:

Documents reviewed and signed: (check all items completed) ______ Liability Waiver ______ Emergency Medical Form ______ Exchange Phone #s ______ Family Information ______ Youth Needs and Goals ______ Youth Interest State the agreed upon plan for first outing:

Describe interactions between youth and adult volunteer, and between parent and adult volunteer:

Describe any unusual occurrences/observations:

Describe any concerns regarding the potential of this match:

Summarize the overall observed potential for this match:

_______________________________________ ________________________ Jeanette Nadonley / Rosi Pena

Date