For Caregivers - Enroll in Girls Rise Up & Find a Mentor for a Girl

We are so grateful for your interest in Girls Rise Up! Please complete the following form in order to enroll your girl in our programming and to ensure that Big Brother Big Sisters identifies your girl as a Girls Rise Up match. After you submit this form, you will be contacted by a representative of Girls Rise Up regarding next steps. We look forward to your girl being a part of our community!

Please note that girls can participate in gatherings only, our mentor program only, or both.

For caregivers who choose to enroll a girl in our mentor program in partnership with Big Brothers Big Sisters, by completing the below form, you are authorizing Girls Rise Up to share the following information with Big Brothers Big Sisters: contact information (email, phone number, address), basic demographic information including date of birth, and match information.

Caregiver's Name:

First Name

Last Name

Caregiver's Email:

Caregiver's Phone:

(###)

###

####

Caregiver's Relationship to Girl:

Girl's Name:

First Name

Last Name

Girl's Birth Date:

MM

DD

YYYY

Girl's Email (optional):

For communication regarding upcoming gatherings after enrollment has been established.

Girl's Participation Interest:

Gatherings

Mentor Program

2nd Girl's Name:

First Name

Last Name

2nd Girl's Birth Date:

MM

DD

YYYY

2nd Girl's Email (optional):

For communication regarding upcoming gatherings after enrollment has been established.

2nd Girl's Participation Interest:

Gatherings

Mentor Program

Girl's Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mother's Name:

First Name

Last Name

Mother's Birth Date:

MM

DD

YYYY

Mother's Date of Death:

MM

DD

YYYY

Mother's Cause of Death:

Please include any additional information you feel is important below:

Electronic Signature:

First Name

Last Name

For Caregivers - Enroll in Girls Rise Up & Find a Mentor for a Girl

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