Girl Talk Girl School & Site-Based Application

  • Participant Information

  • MM slash DD slash YYYY
  • Please specify the name of your school or community site where you would like to enroll.
  • Parent/Guardian Information

  • Please indicate the number of individuals who reside in the household.
  • Medical Information

    This information will be used in the event of an emergency.
  • Emergency Contacts

    Please designate two (2) people we can contact if there is no answer when we attempt to reach you. These contacts MUST BE LOCAL.
  • Grade Release

    At Girl Talk, Inc. we are training our girls to become successful women in today's society and we focus on ensuring academic achievement. I hereby agree to release a copy of my child's report card to Girl Talk staff and/or volunteers at the end of each 9 week grading period.