subject_line
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
First Name
*
Last Name
*
Address
*
Apt. #/Unit
*
Zip Code
*
City, State
*
Contact Number
*
Child Information
First Name
*
Last Name
*
Age
*
School
Favorite Color
*
Dietary/Allergies
*
3 Favorite Songs (Appropriate)
+
-
Favorite Hobbies/Interest
+
-
Child Information
*Please only fill out this information if you have more than one child.
First Name
Last Name
Age
School
Favorite Color
Dietary/Allergies
3 Favorite Songs (Appropriate)
+
-
Favorite Hobbies/Interest
+
-
Child Information
*Please only fill out this information if you have more than one child.
First Name
Last Name
Age
School
Favorite Color
Dietary/Allergies
3 Favorite Songs (Appropriate)
+
-
Favorite Hobbies/Interest
+
-
Emergency Contact
Relationship to Participant:
*
Self
Mother
Father
Guardian
Other
Other
First Name
*
Last Name
*
Phone
*
Alternate Phone
Attire
Please check the box you may need with assistance. Please provide sizes.
*
No, I will not need assistance.
Dress
Shoes
Tights
Hair
Dress Size
*
Shoe Size
*
Tights Size
*
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
Briefly explain what you would like to take away from this experience.
*
Briefly explain what your child would like to take away from this experience.
*
ACKNOWLEDGEMENT
*
I agree to participate in the Date with Dad Weekend that takes place on Saturday June 1,2019 at the DC Correctional Treatment Facility. I am aware that the event is formal attire only and any other attire is prohibited in the facility.
*
I give my consent to be photographed during this event, I am also aware that these photographs may be used for promotional or educational purposes.
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.
Please select a date that best fits your schedule
*
Saturday April 13, 2019
Saturday April 20, 2019
Saturday May 25, 2019
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.
Please select a date that best fits your schedule
*
Saturday April 13,2019
Saturday April 20,2019
Saturday May 25,2019
LOCATION:
TBD
TIME:
TBD
Powered by
Report abuse