Girl Let Go Inc – Bloom Circle Registration & Consent Form

Girl Let Go Inc will not dispense or allow self-administration of medication unless this form is completed by a parent or guardian. I, the parent/guardian of the minor child listed below, give permission for Girl Let Go Inc staff to administer or allow self-administration of medication as outlined.

 

 I understand that medication must be provided in original containers and that I am responsible for informing staff of any changes. I acknowledge risks associated with administering medication and release Girl Let Go Inc from liability related to administration.

 

At Girl Let Go Inc, we are committed to creating a safe, respectful, and empowering environment for all participants. The following expectations help ensure every girl can learn, grow, and feel supported.

Participant Expectations

Participants are expected to:

• Use respectful and appropriate language at all times

• Treat others with kindness, respect, and inclusion

• Follow directions from staff and volunteers

• Keep hands, feet, and objects to themselves

• Stay within assigned groups and designated areas

• Participate positively in activities and demonstrate good sportsmanship

• Respect program materials, property, and space

• Report any concerns, problems, or unsafe situations to staff

1. Only use words that are polite

2. Respect the property of others

3. Not bring or possess any objects that may be harmful to others

4. Not push, hit, or inappropriately touch another participant

5. Respect and obey all staff and volunteers

6. Remain with assigned group or designated program area

7. Demonstrate good sportsmanship and fair play

8. Communicate concerns to staff when needed

Any behavior that disrupts the safety, emotional well-being, or reputation of another participant or the Girl Let Go Inc program may result in disciplinary action, including immediate removal from the program.

In exchange, Girl Let Go Inc staff promise to provide a safe, supportive, and nurturing environment for all participants.

 

Attendance & Participation

• Arrive on time and be picked up on time

• Attend regularly and participate in scheduled activities

• Notify staff of absences when possible

Consistent attendance and active participation are required. Excessive absenteeism, repeated no-shows, or lack of engagement may result in termination from the program.

 We understand that circumstances may arise. Open and timely communication with Girl Let Go Inc is required to maintain participation status.

Dress Expectations

Participants should wear appropriate, comfortable clothing suitable for program activities. Clothing must be respectful and not display inappropriate language or images.

Electronic Devices

Use of phones or electronic devices may be limited during program time. Devices should not disrupt activities or be used inappropriately.

Bullying & Respect Policy

Bullying, harassment, intimidation, or exclusion of any kind will not be tolerated. Girl Let Go Inc promotes a safe, inclusive environment where all participants feel respected and valued.

Girl Let Go Inc, has Zero Tolerance for Cyberbullying (On & Off Program)
Cyberbullying is strictly prohibited. This includes any form of online harassment, intimidation, threats, or inappropriate digital behavior.

This policy applies to ALL interactions between participants, whether they occur:
• During program sessions or events
• Outside of program hours
• On social media, messaging apps, text messages, or any digital platform

Conflict Resolution

Participants are expected to use respectful communication to resolve disagreements, seek help from staff when needed, and avoid physical or verbal conflict.

Safety Responsibility

Participants must follow all safety instructions and guidelines during activities. Unsafe behavior mayresult in immediate staff intervention.

Personal Responsibility

Participants are responsible for their personal belongings. Girl Let Go Inc is not responsible for lost, stolen, or damaged items.

 

Transportation Responsibility

Unless otherwise stated, parents or guardians are responsible for ensuring participants are transported to and from all program sessions, events, and activities.

 

Program Rules

• No use of profane or inappropriate language or gestures

• No possession of items that may cause harm

• No physical aggression (pushing, hitting, inappropriate contact)

• No misuse of equipment or furniture

• Follow all safety guidelines during activities

Parent/Guardian Responsibility Parents/guardians agree to:

• Review expectations with their child

• Support program policies

• Maintain respectful communication with staff

• Provide accurate and updated information

Serious or unsafe behavior may result in immediate removal from the program as outlined in the Discipline Policy. 

Registration Fee Notice

A one-time annual registration fee of $50 is required to join the organization, Girl Let Go Inc. However, "The Bloom Circle" program is free of charge. This fee will be collected at orientation.

 

To ensure a safe and supportive program environment, Girl Let Go Inc follows this discipline policy:

First Incident: A counseling session will take place between the participant and staff member. Theparticipant will be informed of unacceptable behavior and given corrective guidance. Parents/guardians will be notified.

Second Incident: A misbehavior report will be completed. A counseling session will occur with the participant, staff member, and supervisor. The participant may be separated from the group to regain composure. Parents/guardians will be notified.

Third Incident: A misbehavior report will be completed and the participant may be suspended from the program for a period ranging from one day up to removal from the program. In serious cases, parents/guardians may be required to pick up the participant immediately.

Any participant displaying violent or highly disruptive behavior that poses a safety risk may be removed immediately at the discretion of program leadership.

Emergency Situations & Law Enforcement

Girl Let Go Inc prioritizes the safety of all participants, staff, and volunteers.

In the event of serious misconduct, including but not limited to:

- Acts causing or attempting to cause great bodily harm

- Physical assault resulting in injury

- Possession of weapons or dangerous objects

- Threats of violence or credible safety risks

Girl Let Go Inc reserves the right to:

- Immediately remove the participant from the program

- Contact law enforcement and/or emergency medical services (911)

- Require immediate parent/guardian pickup

Any such incidents may result in immediate termination from the program without prior warning.

Girl Let Go Inc will fully cooperate with law enforcement and emergency personnel.

 

 

Girl Let Go Inc. may take photographs and/or videos during program activities for use in promotional materials, including social media, website content, and marketing materials.

No names or personal identifying information will be used without additional consent.

All information submitted is kept confidential and used only for program participation and safety purposes.