Girl Talk Club Leader Application

Girl Talk Club Leader Application
Thank you for your interest in joining a Girl Talk Club! We are excited and can't wait to learn more about you! If you have any questions or concerns regarding the Girl Talk Club Leader application, please refer to our website (Girl Talk Clubs) or email programs@mygirltalk.org for assistance. We look forward to inspiring confident, fearless, and supportive girl leaders together!
Girl Talk Club and Meeting Location Information
Girl Talk Club Name*
If unsure, please ask a current Club Leader or Club Advisor. This information can be found by logging into Girl Talk Connection.
Girl Talk Club Code*
If unsure, please ask a current Club Leader or Club Advisor. This information can be found by logging into Girl Talk Connection.
Club Meeting Location (address where your Club meets regularly)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Girl Talk Club Leader Information
A Girl Talk Club Leader is a teen or pre-teen girl who wants to expand her leadership skills and is interested in mentoring younger girls, sharing her experience, and cultivating an atmosphere of leadership, authenticity, inclusion, and service. It must be completed by the Club Leader (primarily 8th-12th graders) and their parent or guardian.
Name*

First NameLast Name
Email Address (This will be your Girl Talk Connection username. Please use a different email address than other Club Advisors and Club Leaders)*
example@example.com
Home Mailing Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number
Please enter a valid phone number.
Is the phone number above a cell/mobile, home, or work number?

Cell/MobileHomeWorkOther
Birthday*

MonthDayYear
Gender*
If you prefer not to answer, please type in Prefer Not To Answer.
Race/Ethnicity (please select all that apply)*

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoMiddle Eastern or North AfricanNative Hawaiian or Pacific IslanderWhiteMultiracialPrefer Not To AnswerOther - Prefer To Self-Describe
How did you first hear about Girl Talk?

Girl Talk Club ParticipantDove/Sam's ClubPro Volleyball AssociationAerieBarbie Dream Gap ProjectFacebookInstagramTikTokLinkedInInternet SearchFamily/FriendSchool PersonnelCommunity Organization/ Non-ProfitGirl Talk Team MemberGirl Talk Board MemberOther
Do you consent to receiving Girl Talk communication via text?*

Yes, I consent to receiving Girl Talk texts.No, I do not consent to receiving Girl Talk texts.
What Year Will You Graduate from High School?*
Name of High School You Attend*
Zip Code and Country of High School You Attend*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent's/Guardian's Name*

First NameLast Name
Parent's/Guardian's Email Address*
example@example.com
Parent's/Guardian's Phone Number*
Please enter a valid phone number.
Have you participated in any of Girl Talk's programming previous to joining as a Club Leader? (Check all that apply)*

Yes, as a Girl Talk Club MenteeYes, as a Girl Talk Club LeaderYes, as a Girl Talk Camper or CounselorYes, as a Girl Talk AmbassadorYes, as a Participant in the Girl Talk Affirmation Text Messaging ProgramI am new to Girl Talk
Girl Talk Club Leader Agreement

This Girl Talk Club Leader Agreement is between Girl Talk, Inc., a Georgia non-profit corporation ("Girl Talk") and "You", a parent or guardian on behalf of your child participating with Girl Talk Club programs and activities (a "Girl Talk Club Leader" or "Club Leader"). You agree to the below Terms and Conditions upon your child participating in a Girl Talk Club.

A "Girl Talk Club" is a local group that uses Girl Talk materials where Girl Talk Club Leaders mentor Girl Talk Club Mentees.
Terms and Conditions

1. Participation Waiver

Working with children comes with inherent risks. In consideration of participating with a Girl Talk Club, You hereby release and discharge (agreeing to make no claim and not sue to the maximum extent allowed by law) Girl Talk, its directors, employees, volunteers, or agents ("Related Parties") for any and all claims, except to the extent caused by the gross negligence or willful acts or omissions of Girl Talk (or to the extent as required by applicable law), related to the Girl Talk Club Leader's relationship with Girl Talk. GIRL TALK DOES NOT EMPLOY OR HIRE THE LOCAL COMMUNITY LEADERS WHO MANAGE AND ADVISE GIRL TALK CLUBS AND PARTICIPANTS, AND GIRL TALK SHALL NOT BE LIABLE TO YOU, THE GIRL TALK CLUB LEADER, OR ANY THIRD PARTY BASED ON THEIR ACTS OR OMMISSIONS. You agree to indemnify and hold harmless Girl Talk and the Related Parties for any loss, injury, or death caused by You or the Girl Talk Club Leader.

2. Marketing Consent

Unless you send an email to programs@mygirltalk.org or a subsequent identified email address advising that You do not provide such consent and receive a confirmation in reply, You consent to Girl Talk using the Girl Talk Club Leader's name, image, and likeness for its own marketing and donation solicitation purposes, including, but not limited to, on Girl Talk and its partner's websites, social media, and other media as Girl Talk uses for such communications from time to time. You agree that the Girl Talk Club Leader may be photographed or recorded in other media, such as video or audio recordings, in connection with Girl Talk activities or events. You hereby grant Girl Talk an irrevocable, royalty-free, perpetual license to use any and all photographic images and other media recordings taken during Girl Talk activities and events for Girl Talk marketing purposes.

3. Miscellaneous

If any portion of the Agreement is held to be invalid or unenforceable, the invalid or unenforceable portion shall be construed in accordance with the applicable law as nearly as possible to reflect the original intentions of the parties, and the remainder of the Agreement shall remain in full force and effect. The paragraph headings herein are provided only for reference and shall have no effect on the construction or interpretation of the Agreement. If Girl Talk fails to enforce strict performance of any provision of the Agreement, such failure will not constitute a waiver of our right to subsequently enforce such provision or any other provision of the Agreement. Neither the course of conduct between You and Girl Talk shall act to modify any provision of the Agreement.

The Agreement shall be governed by and construed in accordance with the laws of the State of Georgia, except regarding its conflicts of law rules. Any action relating to the Agreement, Content, or Trademarks must be brought in the federal or state courts located in Atlanta, Georgia and You hereby irrevocably consent to the jurisdiction of such courts. Any cause of action you may have with respect to the Agreement, Content, or Trademarks must be commenced within one (1) year after the claim or cause of action arose, or is barred. Additional written terms and conditions posted on the Girl Talk website or executed in writing with You, including but not limited to, a Privacy Policy, govern and, if conflicting, supersede any oral or other communication between the parties.

I certify that I am the parent or legal guardian of the Girl Talk Club Leader, or that I otherwise have the legal authority to represent the Girl Talk Club Leader and act on their behalf. I have read and understood this Agreement. I hereby consent to and ratify this Agreement and agree, on behalf of myself, Girl Talk Club Leader and each of our respective legal representatives, heirs and assigns, to be bound by its terms.
I understand that for my child/ward to serve as a Girl Talk Club Leader, then I consent to all of the above Terms and Conditions.*

I consent to the above Terms and Conditions.
Confirmation

I hereby certify that my child/ward has not been convicted of a felony or any offense involving the physical or sexual abuse, molestation or rape of a child; and that they have not been convicted of a crime of moral turpitude (lying or stealing). I hereby certify that all information provided in this authorization is true, correct and complete and that they agree to abide by all rules, regulations and policies of Girl Talk. I understand that if any proves to be incorrect or incomplete that grounds for canceling any and all participation by my child/ward exists.

By submitting this form, I understand I am delivering electronic signatures that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
Confirmation Consent*

I have read the confirmation section above and we are in complete compliance and agreement.
Girl Talk Club Leader Signature, if over the age of 18 (by signing below, I consent to all of the above waivers)

Clear
Parent's/Guardian's Signature if Girl Talk Club Leader is under 18 (by signing below, I consent to all of the above waivers on behalf of my child/ward)*

Clear
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Girl Talk Club Leader Application

Girl Talk Club and Meeting Location Information

Girl Talk Club Leader Information