Friendly PEERsuasion Program Application (7th) - Fall 2023
Dear Parents & Guardians!

Thank you for your interest in enrolling your daughter in Girls Inc!

We are excited for a new year and a new start! Below please find more information on the program for 7th graders as well as program information:

The Friendly PEERsuasion program is for participants in the 7th grade and focuses on learning good communication skills, stress management, how to resist peer and media pressure, and substance awareness. The program trains the 7th graders to be a positive influence and model healthy behavior for other participants in Elementary School.

The Friendly PEERsuasion program has a total of 9 sessions. We will meet once a week afterschool. We hope to be able to work with your daughter in this program, and have your support. Please complete the following application to enroll your daughter in the program.

Program is being offered at the following sites*:

- Harden Middle School, Salinas
- Washington Middle School, Salinas
- NMC Middle School, Castroville
- Seaside Middle School, Seaside
- Los Arboles Middle School, Marina
- Cesar E. Chavez Middle School, Watsonville
- Main St. Middle School, Soledad
- Vista Verde Middle School, Greenfield
- Chalone Peaks Middle School, King City
- Rancho San Justo Middle School, Hollister
- Rolling Hills Middle School, Watsonville

*The sites you see listed are sites where programs are set to be hosted, but does not mean all girls will be from that school. If you are interested in joining the program, but your school does not appear, please look for the closest site to you.

In order to participate our sessions, each participant must have parental consent. Please fill out the form below and submit your digital signature to confirm your daughter's participation. Following the submission of your application, a Girls Inc. staff member will be in contact with you once there is more information on when the programs will officially start!

Program: Friendly PEERsuasion for 7th graders

Dates/Times: Program will begin in the fall 2023, dates and times vary depending on school sites.

If you have any questions of need more information please contact Lupita at: gbravo@girlsinccc.org or contact the Girls Inc. office at 831-772-0882.

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Participant's Last Name: *
Participant's First Name: *
Middle Name:
Best Contact E-mail for Participant:
Mailing Address: *
Apartment Number: *
City: *
State: *
Zip Code: *
Home Phone Number: *
Cell Phone (reminder text messages):
Would you like to signed up to receive future program updates? (Either email/text message)
School you attend: *
Which school would you like to attend the program at? *
Grade: *
Birthdate: *
Age: *
Ethnic Group:
Clear selection
Race:
Clear selection
Annual Household Income:
Clear selection
Do you Receive Free or Reduced Lunch at School:  
Clear selection
Number of Family Members Living in Household:
Family Type:
Clear selection
Primary Language Spoken at Home:
Clear selection
Parents' Name: Mother's Full Name:
Mother's Best Contact Phone Number:
Father's Full Name:
Father's Best Contact Phone Number:
Best Contact E-mail for Parent: *
In case of an emergency, who can we contact: (Example: Julie Castro (Relationship to participant) (Phone number) )
Is there any information we should know of? (Accommodations/Medical history/ Allergies/ Medications) 
How did you hear about this program?
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