Program Registration Form

Registration Application

Girls Growing into Greatness is proud to serve as the premier mentoring program at Scott Lake Elementary School in the City of Miami Gardens. If your child is a student at Scott Lake and would like to become a member, please complete the form below.
Student's Name*

First NameLast Name
Student's Birth Date

MonthDayYear
Student's Age
Student's Grade Level
Student's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian's Name

First NameLast Name
Parent / Guardian's E-mail
example@example.com
Parent / Guardian's Phone Number
Parent / Guardian's Name

First NameLast Name
Parent / Guardian's E-mail
example@example.com
Parent / Guardian's Phone Number
DEMOGRAPHIC INFORMATION
ALLERGIES: Please list any DRUG allergies.
ALLERGIES: Please list any FOOD allergies. i.e. peanuts, oats, etc.
ALLERGIES: Please list any SUBSTANCE allergies. i.e. dust, pollen, etc.
ALLERGIES: Please list any ANIMAL allergies.
Favorite School Subjects (Check all that apply)

Language Arts / ReadingScienceSocial StudiesMathMusicPhysical EducationOther
Hobbies
Favorite Color
Favorite Food
EMERGENCY/ PICK-UP AUTHORIZATION:
If for any reason I/we cannot be reached, please contact the following person(s) whom I/we hereby authorize to pick-up and/or seek emergency medical care for my/our child. For my child’s safety, I understand that all authorized persons on the list below will be asked to show photo identification before my child is released.
#1 Emergency Contact Person's Name

First NameLast Name Relationship to Student
#1 Emergency Contact's Phone Number
#2 Emergency Contact Person's Name

First NameLast Name Relationship to Student
#2 Emergency Contact's Phone Number
CODE OF CONDUCT

Girls Growing into Greatness provides a safe and exciting atmosphere for girls to acquire self-importance, confidence, and competence. The girls will be exposed and engage in activities geared towards scholastics, etiquette, and service.

As a Member, I will
• Demonstrate role model qualities through my academics and behavior
• Learn, recite, and apply the Girls Growing into Greatness Mantra
• Be RESPECTFUL to myself, my peers, and ALL adults
• Use appropriate language and tone with others
• Be responsible, honest, and kind at ALL TIMES
• Be ON TIME to meetings and events
• Complete my take home activities and have FUN doing them
• Resolve conflict PEACEFULLY with the help of the Mentors
• BE THE BEST I CAN BE and GROW INTO GREATNESS

As a Parent, I will
• Bring my child REGULARLY to all meetings and events. If this cannot occur, I will notify the Lead Mentor in advance
• Drop off and Pick up my child ON TIME from all meetings and events.
• Be respectful of those volunteering their time, respectfully bringing all concerns and comments to Dr. Porter
• Abstain from posting pictures/photo/video of other Mentees, Mentors and Parents on social sites (i.e. Facebook, Instagram, X, YouTube, etc.) without prior approval
• Refrain from bringing guests/relatives to closed events & meetings without prior approval
• Support ALL expectations to ensure that my child is GROWING INTO GREATNESS

If your child DOES NOT meet Code of Conduct expectations, misses 3 meetings and/or displays severe behavior/academic concerns, she will be removed from the group.
ACKNOWLEDGEMENT OF CODE OF CONDUCT
I am excited to join Girls Growing into Greatness, and I look forward to all the
wonderful experiences ahead. By signing below, I agree to fulfill my
responsibilities.

I with my parent/guardian, have read and understand the Code of Conduct and sanctions for violating the Code of Conduct.

I have read and understand that my child’s compliance with the Code of Conduct is a condition of her participation in the Girls Growing into Greatness program at Scott Lake Elementary School. I agree that the sanctions for violating the Code of Conduct are reasonable, and I will help my child comply.
MEDIA RELEASE FORM

Dear Parent or Guardian:
Please be advised that during this year, your child may be photographed, videotaped, or interviewed during the various Girls Growing into Greatness activities or events. With your consent, the photograph, video, or interview may be reproduced and released for use by the school, newspaper, or brochures.
Please indicate below:
Type Member’s Name:

Indicate "Yes": Yes, my child’s photograph/video may be reproduced and released.

OR

Indicate "No": No, my child’s photograph/video may not be reproduced and released.
Parent / Guardian Signature #1 *

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Parent / Guardian Signature #2

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Registration Application