Daughter of Destiny Mentorship Program Registration & Consent

Daughter of Destiny Mentorship Program Registration & Consent

Register your daughter for the Daughter of Destiny Mentorship Program and provide parental consent. Please review the program details below before completing the registration.
Registration Packet

Please download this PDF to review the packet details. If you need to print or save this document, use the 3 dots on the upper right corner of the form.
Mother’s Name
Father’s Name
Address
City
State
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Daughter’s Name
Daughter’s Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Daughter’s Date of Birth

MonthDayYear
Date
Allergies
School
Grade
Career Path
Hobbies
Emergency Contact Name
Emergency Contact Address
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parental Consent
I give permission for my child, to participate in the Daughters of Destiny mentoring program. I understand the nature and rules of the program’s mentoring efforts and reserve the right to withdraw my child from the program at any time.
Child’s Name
Parent/Guardian Signature
Parent/Guardian Signature Date

MonthDayYear
Date

USDPAYMENT AMOUNT

Registration Packet