Girls Thrive After School Enrichment and Mentoring Program Applicationication

GirlsThrive After School Enrichment and Mentoring Program

Welcome to the Girls Thrive Afterschool Enrichment and Mentoring Program! Our mission is to empower young girls to develop the skills, confidence, and leadership abilities they need to thrive both in school and life. Designed for girls ages 8-18, our diverse programs support personal growth, academic success, and overall well-being in a fun, engaging, and supportive environment.

Program Overview All programs run for 18 weeks, divided into three engaging 6-week sessions. Participants can choose individual sessions or commit to the full 18 weeks to maximize their experience. Please note: transportation is not provided at this time, and parents/guardians are responsible for getting participants to and from the program.

Full Name

Preferred Name (If different)

Date of Birth

MonthDayYear

Grade Level

School Name

City

State

ZIP Code

Phone Number (Applicant's):

Email Address (Applicants):

Parent/Guardian Name:

Relationship to Applicant:

Phone Number (Parent/Guardian):

Email Address (Parent/Guardian):

Emergency Contact Phone Number:

Emergency Contact Name:

Applicant's Relationship to Emergency Contact:

How did you hear about the Girls Thrive After School Program?

Social MediaSchoolFriend/FamilyOther

Why are you interested in joining the program?

Do you have any previous experience with youth programs, clubs, or organizations?

YesNo

If yes, please describe:

Which session are you interested in? (Check all that apply)

Thrive Tribe Chats (Middle School- 6th-8th grade/High School- 9th-12th grade) Dates: Session 1: January 27, February 3, 10, 17, 24, March 10, 2025 (Off for Mardi Gras) Time: Middle School: 4:00 PM - 5:15 PM I High School: 5:30 PM-6:45 PM Cost: $100 per 6-week session or $20 per drop-in classNext Level Living: Preparing for Independence (Middle School- 6th-8th grade/High School-9th-12th grade) Dates: Session 1: January 28, February 4, 11, 18, 25, March 11, 2025 (Out for Mardi Gras) Time: Middle School: 4:30 PM - 5:30 PM I High School: 5:45 PM - 6:45 PM Cost: $100 per 6-week session or $20 per drop-in classGirlpreneur: Empowering the Future of Female Entrepreneurs (High School 9th- 12th grade)Dates: Session 1: January 29, February 5, 12, 19, 26, March 5, 2025 Time: Wednesdays: 5:00 PM – 6:30 PM Cost: $120 per 6-week session or $25 per drop-in classAdulting Academy (High School 9th- 12th grade) Dates: TBD Time: TBD Cost: $100 per 6-week session or $20 per drop-in classHealthyHER for Younger Girls: Building Healthy Habits Early (Elementary School 3rd-5th Middle School- 6th-8th grade) Dates: TBD Time: TBD Cost: $100 per 6-week session or $20 per drop-in classHealthyHER: Nutrition & Fitness for Life (Middle School- 6th-8th grade/High School- 9th-12th grade) Dates: TBD Time: TBD Cost: $100 per 6-week session or $20 per drop-in class

What are some hobbies or activities you enjoy doing in your free time

What do you hope to gain from the Girls Thrive After School Enrichment program

What are two personal goals you would like to achieve during your time in the program?

1

2

Health and Wellness Information

Do you have any allergies, medical conditions, or dietary restrictions we should be aware of?

YesNoOther

If yes please explain

Participants are responsible for arranging their own transportation to and from the program. Are you able to provide transportation to and from the program?

YesNo

Drop-in rates are available for participants who prefer not to commit to a full session. Advance registration is required, and spots are offered on a first-come, first-served basis. Secure your spot by paying for a full 6-week session upfront. Discounted rates available for multiple sessions paid in advance.

Will you require financial assistance to participate in the program?

YesNo

If yes a sponsorship request form will be provided upon acceptance into the program

During the program, photos and videos may be taken for promotional and documentation purposes. Do you consent to the use of your image in The Confidence Campaign media (e.g., social media, website, brochures)?

YesNo

Behavior and Participation Agreement: By joining the Girls Thrive After School Enrichment and Mentoring Program, I agree to participate fully in all scheduled activities, abide by the program rules, including payment policies, and respect fellow participants and staff.

Applicant Signature

Date

MonthDayYear

ParentGuardian Signature

Date

MonthDayYear

For more information, contact us at TheConfidenceCampaignorg@gmail.com or

visit our website at:TheConfidenceCampaign.org