NEW GWP Application

DESTINY'S DAUGHTERS OF PROMISE

Girl with Promise Program

(To be Completed Only by Parent/Guardian)

Criteria for Acceptance:

The following criteria will be used to determine eligibility:

Teen must be entering grades 7^th - 12^th in the fall.
Agree to the Consent Section.
Pay a non-refundable registration fee of $30.
Your payment for the registration fee will be due when you click the submit button on the application in order to secure your spot in the program.

Once we have reviewed your completed application and received your registration fee, we will contact the teacher or school administrator you listed on your application to verify your child's information. We will follow-up with you to notify you of your child's acceptance into the program.

Should you have any problems with the application, you may contact us at info@ddpgirls.org or give us a call at 770-485-5894. We look forward to receiving your information promptly and partnering with you to prepare your daughter for college, careers and a life of bold success.

STUDENT INFORMATION

Date*

Parent/Guardian Name*

First Name

Last Name

Parent/Guardian Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Parent/Guardian Telephone*

Parent/Guardian Cell Phone*

Parent/Guardian Email*

Youth Name*

First Name

Last Name

Youth Cell Phone

Date of Birth*

Age at start of GWP Program*

Ethnicity*

Grade:*

Free or Reduced Lunch*

Name of School Youth is Attending*

T-Shirt Size*

Why are you interested in joining GWP?*

How did you hear about the GWP Program?*

Name of School Teacher, Counselor or Administrator Who Recommended You:

First Name

Last Name

Phone Number of Person Recommending You

TRANSPORTATION CONSENT

I hereby acknowledge and give my consent for my child to be picked up by:*

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Name

First Name

Last Name

Phone

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Do you give DDP staff permission to give your daughter a ride home from DDP activities should you be unable to provide transportation?*

PAYMENT

GWP Registration Fee* $

GWP Reg # of child

GWP T-Shirt Fee* $

# of child for GWP T-Shirt

ADDITIONAL DOCUMENTS

Please upload a copy of your child's most recent report card.

No File Chosen

File uploads may not work on some mobile devices.

Acceptable file formats are jpg, jpeg, png, pdf, doc, docx

Consent:*

I agree with Consent:

I have provided Destiny’s Daughters of Promise with all of the necessary medical information needed. I can be reached at the numbers I listed above if there is an emergency. I acknowledge and accept the risk for any accidents or injuries arising by reason of participation in the program, including activities such as sports or exercise, by myself or the person who is shown as the "participant." I release the Destiny’s Daughters of Promise Program of all liability of injury, death, or other damages to me, my child, family, estate, heirs, or assigns that may result from her participation in the program, including but not limited to transportation, and hold harmless any Destiny’s Daughters of Promise mentor, program staff, or other representatives, both collectively and individually, of any injury, physical or emotional, other than where gross negligence has been determined. I give consent for pictures of the participant or materials produced by the participant to appear in media or marketing materials of Destiny’s Daughters of Promise or our partners.