Parental Permission Form for Girls/Boyz First!!

I, ____________________________, give permission for my daughter/son,_______________to

participate in activities with ______________________, a mentor with Girls/Boyz First!! In addition, I

give my permission for my daughter/son, ___________________, to ride in the car with her/his

mentor as needed in order to participate in Girls/Boyz First activities that are not within walking

distance from home. In the event of a medical emergency, I give my permission for medical staff to

treat my daughter/son,___________________. I also give permission for her/his mentor to pick

her/him up from school if an activity requires it, so long as I have given prior consent to the activity.

Further, I understand that the individuals who serve as mentors in this program are volunteers

and not employed by Girls/Boyz First!! or by the Washington Central or Montpelier school district.

Girls/Boyz First!! is a program offered through Community Connections, and Central Vermont New Directions,

non-profit organizations providing support and resources to the youth of Central Vermont. I also understand that

Girls/Boyz First!! mentors will receive ongoing support from the director of the program.

Signature of Parent or Guardian:

_________________________________Relationship:__________________________

Date_______________