Girls of Excellence, Inc. Parent/Guardian Consent Form
We are excited that your daughter is interested in joining the Girls of Excellence (GOE) Program! Your permission is needed for your child's general participation in the GOE Mentoring Program and the release of information your child's grades, attendance and behavior.  Please complete and submit this form for your child's participation in the program.  
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CONSENT TO PARTICIPATE:  I consent for my daughter, to participate in the mentoring program sponsored by Girls of Excellence, Inc. (GOE). GOE meets virtually bi-weekly or weekly for 60-90 minutes during the school year.  I am aware that GOE is a local 501(c)3 nonprofit organization that offers mentoring programs for girls and participation involves meetings, group outings and community service.  I agree to hold harmless GOE against any liability, loss or expense incurred or suffered in consequence of any action or actions, suit or suits, in law or equity, which may be brought by any person or persons in connection with, or with reference to, the administration, planning, preparation, development, conduct and execution of the GOE mentoring program.  I understand that my child may engage in discussions pertaining to drugs, alcohol, sexual behavior, dating, violence and other sensitive topics.  I understand that my daughter will participate in the program from Fall 2020 to Spring 2021.  Please indicate your daughter/mentee name below: *
VIRTUAL MENTORING:  I, the undersigned, grant permission for my daughter to participate in virtual group mentoring with the Girls of Excellence, Inc. Program.  I understand that the organization has taken measures to ensure a safe interaction(s)with her mentor such as interviewing, training and comprehensive background checks. Please initial below. *
RELEASE OF SCHOOL RECORDS/INFORMATION:  I, the undersigned, consent to GOE and their program and evaluation staff to have access to my daughter’s school records.  I agree to allow my daughter’s school to release their school records including grades, attendance and discipline records for the purpose of research and presenting impact data.  I understand that my daughter will complete a confidential survey about her attitudes and opinions about the program as part of an evaluation.  I understand that the information provided by the school and my daughter will be statistically analyzed and that my daughter’s name will be withheld for confidentiality purposes.  I understand that this information, in addition to the survey, will be a component of the larger evaluation process and only the program and evaluation staff will have access to the confidential information.
TRANSPORTATION:  When possible and if necessary, I, the undersigned, hereby grant permission for the GOE program staff/volunteers to transport my daughter to and from various activities and hold harmless GOE against any liability, loss or expense incurred or suffered in consequence of any action or actions, suit or suits, in law or equity, which may be brought by any person or persons in connection with, or with reference to, the administration, planning, preparation, development, conduct and execution of the GOE mentoring program. Parents will be notified in advance if transportation will not be provided to an outing or event. Parents will then be responsible to secure transportation for their daughter to participate in an event or outing.  
PHOTO RELEASE:  I, the undersigned, hereby grant permission to GOE to take and reproduce photographs for publication, including publication by news sources and other sources for all educational, trade, advertising and other purposes as determined by GOE.  These images may be used for GOE displays, brochures, newsletters, archives, news releases, publicity, social media and Websites.
Mentee must agree to participate in the Girls of Excellence, Inc. (GOE) Mentoring Program and agree to: Meet with my mentor every week or every two weeks during the scheduled time.  Notify my mentor if I cannot meet with her for any reason. Attend all required program activities outside of meetings at school. Participate in outings, field trips, community service projects and GOE Events.  Communicate with my mentor and/or School Coordinator if I feel uncomfortable or experience problems during the program.  Abide by the rules and regulations of the school and the Girls of Excellence, Inc. Mentoring Program.
Parent/Guardian Name: *
Address: *
Phone: *
Email *
Emergency Contact Name: *
Emergency Contact Phone: *
Mentee/Daughter Name: *
Date of Birth:
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Age: *
Phone Number (Mobile if available) *
Mentee Email Address: *
School: *
Grade: *
School Counselor Name: *
Mentee Lives with: *
Required
Mentee/Daughter T-Shirt Size *
What three words would you use to best describe your daughter? *
What type of changes would you like to see in your daughter after participation in GOE? *
Are you willing to volunteer and/or support the organization? If yes, in what capacity *
Is there any additional information you would like us to know about your daughter that will be helpful in mentoring her? *
By signing/printing your name below, you have read and completed the above consent form and are providing consent for your daughter to participate in the GOE Program: *
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