Girls Link Up Interest Form

2024-2025 Mentoring Programs

Girls Link Up is a mentoring program for girls that supports their social and emotional needs while exposing and empowering them to S.T.E.A.M. college and career pathways. Girls Link Up works to bridge the gap between women and STEAM through engagement and exposure.
Student's Name*

First NameLast Name
Current School Grade*
We only accept girls in 3rd - 8th grade.
Current School *
Date of Birth*

MonthDayYear
Age:*
Student ID Number
Please select all that you may be interested in attending.

Girls Link Up - After-School Program (SY 2024-2025)Girls Link Up on the Weekend (Monthly Saturday Events)Math Stars - Free Tutoring Services (Starting October 2024)Mom Circles - Monthly parent engagement events.Girls Link Up Summer Camp 2025 (June 9 - July 3, 2025)

PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Home Phone Number

Area CodePhone Number
Business Phone Number

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
E-mail*
Mom Circles

Mom Circles is an outreach program that is committed to equipping, empowering and educating mothers in the community with resources to support their social and emotional needs.
Are you interested in learning more about our Mom Circles Program?*

YesNo
Media Release Statement - Funding sources may require footage and evidence of program execution. Meetings may be recorded periodically. 1) I, the undersigned, authorize 3D Girls, Inc. to photograph, take motion pictures, take video footage, and/or make electronic sound recordings (herein referred to as photographic or electronic reproductions). 2) I authorize the use of any such photographic or electronic reproductions for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by 3D Girls, Inc. (I understand that I may be identifiable from such photographic or electronic reproduction)
I HEREBY GIVE consent to the collection and use of my child’s personal images by photography or video recording.I DO NOT give consent for 3D Girls, Inc. to collect and use my child’s personal images by photography or video recording.
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2024-2025 Mentoring Programs