Form
Name
*
First Name
Last Name
Child's Name
*
First Name
Last Name
Child's Name
First Name
Last Name
Child's Name
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Child's Date of Birth
-
Month
-
Day
Year
Date
Child's Date of Birth
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Ages of Child(ren)
*
Current Grade Level(s)
*
Do you give permission for your child to be photographed or filmed for promotional and marketing purposes? (Our website, news outlets, magazines, and more)
*
Yes, I give permission
No, I do not give permission
Do you give permission for your child to attend field trips, outings, slumber parties, and events with Rescue the Children G.I.R.L.S Mentorship Program?
*
Yes, I give permission
No, I do not give permission
Rescue the Children holds no liability for injuries or incidents. In the event of an emergency or accident I understand Rescue the Children is not liable for any instances and I cannot take any legal action against the organization.
*
Yes, I understand
No, I disagree
My Products
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next
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Mentorship Program
$
35.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
Signature
*
Submit
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