Student Challenges: Please check all that apply.
Parent/Guardian 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.