Girl Circle Registration
8-10- Week Program for youth ages 10- 13. Young women gain the vital opportunity to address female definitions and behavior and build their capacities to find their innate value and create good lives, individually and collectively.
Next Session will begin on Wednesday, October 2, 2019, and will be held at our office, 42 W. 8th Street in Tracy.
Date of Request
Participants First Name
Participants Last Name
Has the Participant ever attended a Sow A Seed program? (check all that apply)
Boys to Men Conference
Fresh Start Thinking
One-on-One Counseling / Family Thearpy
Y.L.I.A ( Young Leaders in Action)
Participant's Age (ages 10-13 only)
Participant's Birth date (type in correct year)
Participant's School Name
Participant's Currant Grade
Other ( if "Other" please list below)
If "Other" City, please list here
Contact Phone Number (ie. xxx-xxx-xxxx)
Other Phone Number (ie. xxx-xxx-xxxx)
I give permission for the participant listed above to Girl Circle. I also waive, release and discharge all claims for personal and property damages arising from my child's participation
Yes, I give permission. I am the parent of the participant listed above
Yes, I give permission. I am the guardian of the participant listed above
I do not give permission for attendance
Parent/ Guardian Name ( First, Last)
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This form was created inside of Sow A Seed Community Foundation.