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Enroll My Daughter

Student Information

Student's Birthday
Gender

Student Challenges: Please check all that apply.

Parent/Guardian information

Household information

Student health information

Emergency Contact besides parent or guardian if you cannot be reached (Must be someone who lives in Central Ohio):

Please check one of the following boxes and sign below:

Please check one of the following boxes and sign below:


Permission for Mentoring: I, the parent or legal guardian of the above student, consent and agree that my child may participate in the Girls L.E.A.P. mentoring program. I understand that information regarding my student’s progress in school subjects may be shared with program staff and my student’s mentor.

Date
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