R.E.A.L Girlz Big Sister Mentorship Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please register to participate in R.E.A.L Girlz Big Sister Mentorship Program. Applicants must be between the ages of 9 - 13 years old.

Email *

Name of Student *

School Student Attends *

Student Grade *

4th

5th

6th

7th

Parent Name and Contact Information- Please write full name of parent and email address

Please provide an emergency contact number.

Please provide information for parent or guardian authorized to pick up your daughter from our sessions. *

Do you reside in Chippenham Place Apartments? *

Yes

Do you have any concerns about your daughter's social and emotional development? *

Do you have any allergy concerns? *

Yes

Required

If yes, please indicate what you daughter is allergic to.

Is your daughter able to attend our bi-monthly sessions? Session are held on the 1st and 3rd Saturday of each month 11:30 - 1:00 pm *

Yes

Please read carefully and check each of the following boxes below and then sign below. * *

I give my informed consent and permission for my child to participate in the Pretty Purposed program and its related activities. I give my consent for the program to collect data that informs and improves the program. This includes but is not limited to surveys, focus groups, etc.

I consent to having my photo/video taken for promotional purposes across R.E.A.L Girlz and Pretty Purposed platforms.

understand that violation of mentoring program guidelines may result in dismissal or temporary suspension from programming

I release Pretty Purposed of all liability of injury, death, or other damages to me, my child, family, estate, heirs, or assigns that may result from his/her participation in the program, including but not limited to transportation, and hold harmless any Pretty Purposed volunteer, or other representatives, both collectively and individually, of any injury, physical or emotional, other than where gross negligence has been determined.

R.E.A.L Girlz Big Sister Mentorship Program will be meeting face to face, and following COVID-19 guidelines such as conducting health screenings, temperature checks, wearing masks, and social distancing. Please understand that if you choose to mentor during the year, we require you to wear a mask, and we cannot be held responsible for the injury, loss, claims, litigation, sickness, death, expenses now or in the future, directly or indirectly related to COVID-19 in connection with participation in the services we provide. By signing below, you acknowledge that you release Pretty Purposed of liability, and you understand the full risk associated with in person meetings.

I will pick up my daughter promptly at the end of each session.

Required

Anything else you would like for us to know about your daughter?

Thank you for completing the registration form.

R.E.A.L Girlz Big Sister Mentorship Program provides group mentoring to girl using Pretty Purposed Program Curriculum. You can follow R.E.A.L Girlz on social media @r.e.a.l_girlz and Pretty Purposed @prettypurposed. If you have questions regarding your registration, please contact Ms. Johnson.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Flawless Imperfections LLC. Report Abuse

Forms