DATE WITH DAD WEEKEND 2019 PERMISSION SLIP

Girls For A Change & DC Department of Corrections
June 1st 
11:00am - 2:00pm 
DC Correctional Treatment Facility 
1901 E Street S.E.
Washington, DC 20003

Parent Information

Child Information

3 Favorite Songs (Appropriate)
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Favorite Hobbies/Interest
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Child Information

*Please only fill out this information if you have more than one child.
3 Favorite Songs (Appropriate)
+-
Favorite Hobbies/Interest
+-

Child Information

*Please only fill out this information if you have more than one child.
3 Favorite Songs (Appropriate)
+-
Favorite Hobbies/Interest
+-

Emergency Contact

Relationship to Participant: *
 

Attire

Please check the box you may need with assistance. Please provide sizes. *
Please be advised, the following attire is prohibited inside the facilty. 
 
No Hats               
No Head Wraps 
No Tank Tops 
No Crop Tops
No Shorts 
No Leggings 
No Sweatsuits 
No Sneakers 
No Flip Flops 
No Slippers 

Experience

ACKNOWLEDGEMENT

 *
 *

Mom Workshop: Understanding Dad

This workshop will focus on real life tactics and resources that would help mothers cope on the
incarceration of their child's father. 
LOCATION: TBD
TIME: TBD

Daughter Workshop: Sisters of Nia

This workshop will help girls gain coping mechanisms through their journey on the incarceration
of their fathers. 
LOCATION: TBD
TIME: TBD