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Program – Girl Action Team

Program - Girl Action Teams

Step 1 of 5 - Personal

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  • Date Format: MM slash DD slash YYYY
  • MEDICAL TREATMENT/FIRST AID AUTHORIZATION I grant permission for the administration of First Aid to my child by the staff of Girls For A Change (GFAC), and those transporting my child to and from programs as their judgment deems advisable, and to make the necessary referrals to qualified physicians for treatment of illness or accidents of a more serious nature. I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when a delay in such communication would endanger life. In case of medical emergency, I understand that every effort will be made to contact the parent/ guardian of the participant and emergency contact. In the event that I cannot be reached, I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed necessary for my child. *

  • INSURANCE INFORMATION (OPTIONAL)

  • Agreement Form for Transportation

  • I, the undersigned parent or legal guardian, release GFAC, or any other person acting on their behalf, from liability for any bodily injury sustained and loss or damage of any personal article while on the premises or participating in any activity provided by GFAC.

  • Unless a letter to the contrary is received, GFAC accepts your consent for us to take photos and share them on social media as well as GFAC main website.

  • Apply for Girl Action Teams

  • (check all that apply)

  • This field is for validation purposes and should be left unchanged.

Girls For A Change (GFAC) is a 501(c)(3) nonprofit youth development organization aimed at empowering Black girls in Central Virginia to visualize their bright futures and potential through discovery, development, innovation, and social change in their communities.

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100 Buford Road
North Chesterfield, VA 23235

(804) 405-2827

info@girlsforachange.org

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