Girls Mentor Program

I.M.A.G.E. Inc. Girls Mentor Program

The Girls Empowerment Mentor Program is a FREE 12 session program designed to inspire, uplift and equip young girls ages 12–17 with the confidence and skills they need to become all they are destined to be.
Launching December 2025, this program will connect girls with dedicated mentors who will guide them through interactive sessions focused on personal growth, leadership, education, and self-love.

Each week, participants will engage in activities, discussions and hands-on workshops covering topics such as:

Building Self-Esteem & Confidence 💎
Leadership & Communication Skills 🎤
Academic Success & Goal Setting 🎯
Health, Wellness & Self-Care 🧘🏽‍♀️
Financial Literacy & Career Exploration 💼
Community Service & Giving Back ❤️

The program will conclude with a Graduation & Recognition Ceremony where each young lady will be celebrated for her achievements, growth, and commitment.

Who Can Join: Girls ages 12–17
Program Dates: December 2025-May 2026
Format: (2)- 90 minutes In person sessions per month

*All girls apart of this mentor program will have the opportunity to attend a 3 day Girls Weekend Retreat in June 2026

Presented By: Inspiring Minds And Giving Encouragement Inc. (I.M.A.G.E. Inc.)
Mentee Name*

First NameMiddle NameLast Name
Current Grade*
School Attending*
Best Contact- Phone Number*

Area CodePhone Number
Mailing Address *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information (1)
Parent Guardian (1) Name*

First NameMiddle NameLast Name
Home Phone Number*

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Parent/Guardian (1) E-mail*
Address same as child?*

YesNo
Address if different than the child. If your address is different than the child's please fill out the info below. Otherwise move onto the next section.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the child have any allergies? If yes, list any food or medicine allergies below.*
Does the child have any medical conditions? If yes list all medical conditions below.*
Does the child require any medication? If yes, please list these medications.*
Please list the people authorized to pick up your child for mentor sessions, events etc…. (If you will be the only one picking up your child please put N/A) *
Emergency Contact - Other than Parent/Guardian
Emergency Contact Name*

First NameMiddle NameLast Name
Emergency Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Person completing this form
Parent/Legal Guardian Signature

Powered by Jotform SignClear
Should be Empty:

I.M.A.G.E. Inc. Girls Mentor Program

Parent/Guardian Information (1)

Emergency Contact - Other than Parent/Guardian