Girls Empowerment Group Registration and Consent form
The Girls Empowerment Group is a once-a-week after-school program for youth 12-16. The group is open to femme and female youth, including but not limited to trans, non-binary, gender fluid, 2spirit and any other youth female/femme-identified youth in the community of North Vancouver. The group will be a safe space to empower youth through arts-based activities, workshops and presentations from leaders and champions of gender justice in our community. With an experienced facilitator, some of the topics the group will engage with include:
• Self-love
• Building confidence
• Healthy relationships
• Self-esteem
• Gendered discrimination  
• Community safety
• Social change
• Sexual and gender-based violence


The group is free of cost and will meet once a week on Wednesdays from 4-5pm at the North Shore Women’s Centre (131 East 2nd St, North Vancouver) from January 12th-May 11th. The group will not run during the North Vancouver School District spring break holiday (March 16th and 23rd).

For more information email emily.booker@mail.mcgill.ca. Emily will be the facilitator, she grew up in North Vancouver and recently finished a Master's of Arts from McGill University in the department of Education and Society. Emily has worked with youth for over 8 years in a wide range of programming with a focus on mentoring, arts and youth empowerment. Over the last year she has picked up some new covid-safe hobbies including weaving and golf!
Sign in to Google to save your progress. Learn more
Participants First Name *
Participants Last Name *
Participants Age *
Participants School *
Participants Phone Number *
Participants Email Address *
Guardians Full Name   *
Guardians Phone Number *
Guardians Email Address *
Emergency Contact (Name, relation to participant and phone number) *
Family Doctor + Phone Number
Participant's allergies or other health concerns we should know about. *
At any time due to such circumstances as accident or sudden illness, I hereby give permission for emergency medical treatment to be obtained for the youth participant. I understand that a representative of Girls Empowerment Group will attempt to contact me prior to leaving the project/ activity site or upon arrival at the emergency destination, and I will be responsible for any and related expenses incurred, including ambulance or taxi costs. *
The parent/legal guardian/ other person authorized to provide consent in respect to the youth hereby consent to the use in any of Girls Empowerment Group and their partners’ publication of youth’s image if contained in any photographs or other media created during Girls Empowerment Group program or activities.   *
In consideration of the youth participant being permitted to participate in the group/program the parent/legal guardian/other authorized person is to provide consent in respect of the youth herby:-   consent to participation by the youth in any program or activity of Girls Empowerment Group which they or she chooses to participate in.-   release Girls Empowerment Group and their partners (The Pathy Fellowship Foundation, The North Shore Women’s Centre and the More Than Words Project) or other youth from any damage to property, personal injury or death, action, claim, cost, expense or liability whatsoever that they or the youth have, have had or may have arising out of or occurring in connection with the youth’s participation in any program or activity of the group. Signature (type full name here) *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms