Girls on the Run of New Castle County, Inc.
Educating and preparing GIRLS for a lifetime of self-respect and healthy living
Dear Girls on the Run Family,
WELCOME to Girls on the Run! This letter confirms that you are registered at the following site: Wilmington Friends School. We look forward to your participation in Girls on the Run and hope that you are going to have as much fun as we are! It will be wonderful getting to know you all. Below are a few things for you to consider bringing each day that you participate in the program:
1. Always bring athletic shoes, preferably running shoes to workout in. Don't forget to bring socks too, because without them you might get blisters.
2. Please wear clothes appropriate for running and playing. Shorts and a t-shirt work best. You can bring these and change into them, if you don't have time beforehand. If it is really hot, wear light colored, loose-fitting clothing. If it is very cold, layering clothes works best - wear an undershirt with a sweatshirt and/or sweat pants. You may need to wear a warm hat and mittens if it gets really cold.
3. Always bring a full water bottle.
4. Always come ready to be yourself. Everyone is valued, whether they run really fast or not. As a matter of fact, running and walking is fun, but being a part of Girls on the Run is the most fun.
5. We need you and your family to fill out - the attached Health Consent and Waiver Form. Please bring this with you on your first day.
First meeting date and time / Monday, March 31 at 3:00pmMeeting Days / Mondays and Wednesdays
Gathering location / Outside Lower School art rooms
Sunny workout location / Upper School field
Rainy location (we still meet): / Lower School classrooms/pick up at LS
Pick-up location and time / Upper School field at 4:00pm
NOT meeting due to school holiday / May 26th, Memorial Day
“Girls on the Run 5K” / Saturday, May 31st
Last session / Wednesday, May 28th
If you have any questions, please call our GOTR program director, Kim Chitty at 893-2222 or contact your coaches and we will be more than happy to talk to you. We look forward to a great season!
Health Consent and Waiver Form
Parent/guardian must sign and return this 3 page form by THE FIRST DAY OF THE PROGRAM
Girl’s Name:
School Name:
Name of GOTR site:
Age: ______Birthday: _____/_____/_____ (MM/DD/YY) Grade:
Parent/Guardian’s Name(s):
Street Address:
City / State / Zip:
Phone (cell) ______(home)
Optional Race/Ethnicity Disclosure (some of our charitable donors collect this information):
White ÿ African American ÿ Hispanic ÿ Asian ÿ Other: ______
Health Issues
During exercise, physical changes may occur. These changes may include heat-related illnesses, abnormal heartbeat and blood pressure, and, in very rare instances, life-threatening illnesses or conditions. Please check if your daughter has any of these problems:
Heart disease or heart problems Hypertension - high blood pressure
Stroke Diabetes or abnormal blood sugar test
Epilepsy or seizures Abnormal chest X ray
Asthma-Allergies Use Inhaler
Food Allergies. If so, what foods?
Orthopedic or muscular problems
Any other major health problems (if yes, please list): ______
Use of prescription drugs (if yes, please list drugs)
Do you live with or spend a lot of time with someone who smokes cigarettes?
Do you have close relatives (mother, father, sister, brother) who have a history of heart disease?
Is the participant covered by family medical/hospital insurance? (please circle) Yes No
If yes, indicate carrier or plan name: ______
Group #: ______
Carrier Address:______
Name of Insured:______
Relationship to Participant:______
Heath Consent and Waiver Form (page 2)
Permission to provide necessary treatment or emergency care:
I hereby give permission to the medical personnel selected by Girls on the Run to provide transportation and obtain medical care for my child. In an emergency, if neither myself nor my emergency contact can be reached, I hereby give permission to the physician selected by Girls on the Run to secure and administer treatment, including hospitalization for the person named above (Girls on the Run participant).
______
Signature of parent/guardian Date
Emergency Contact(s):
Name ______Phone
Name ______Phone
Child’s Physician:
Name ______Phone
Release
Please indicate how you would like us to release your child at the end of each session. (You may check more than one.)
ÿ One of the following people will pick up my child: ______
______
ÿ My child will walk to the following location unescorted:
Photographs
Occasionally, we film the girls at workouts and races for our own scrapbook, for the girls, or for the facility. May we use photographs and videos of your child participating in workouts or races in our brochures or informational materials?
ÿ Yes ÿ No
Pre/Post Evaluation
As part of our national program, we participate in a survey of the girls, designed to assess the changes in attitudes, beliefs and skills of the program. May we include your child in this survey?
ÿ Yes ÿ No
GOTR History
Has your daughter participated in GOTR during a prior season? Yes ÿ No ÿ
Has your daughter participated in a 5K race with GOTR? Yes ÿ No ÿ
Heath Consent and Waiver Form (page 3)
Program Authorization
I, the undersigned parent or guardian of the child identified below, intending to be legally bound by my signature here, certify that I have read this form and understand there are inherent risks associated with running and physical activity, including possible permanent injury or even death. I agree to assume all of those risks on behalf of my child. I recognize it is my responsibility to provide accurate and complete health information for my child in a timely manner to GOTR-New Castle County, and state that to the best of my knowledge, my child is physically healthy and able to participate in this program and that I have not been informed otherwise by any doctor or medical professional. As a condition of my child’s participation in the GOTR-New Castle County program, or any activity related to the program, I hereby waive any and all rights to claims for loss or damages, including all claims for loss or damages caused by negligence of GOTR-New Castle County or GOTR-National, any other organizers, sponsors, or any individuals officiating or supervising GOTR activities or races.
Child’s Name (print please) ______
Parent/Guardian’s Signature ______Date ______
Race Authorization
I know that a road race is a potentially hazardous activity. I should not enter unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely participate in and compete the run. I assume all risks associated with running this event including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of you accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the City of Wilmington, Girls on the Run, and all sponsors and their employees, their representatives and successors from all claims of liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all of the forgoing to use any photographs, motion pictures, recordings or any other record of this event for any legitimate purposes.
Signature: (parent or guardian if under 18 years old): ______
ONLY FOR SCHOLARSHIP APPLICANTS
Please disregard if you did not chose the financial assistance payment
Educating and preparing girls for a lifetime of self-respect and healthy living
Scholarship Policy Statement
PLEASE READ CAREFULLY!
It is the policy of Girls on the Run of New Castle County to offer our program to all girls who desire to participate in our program, regardless of their financial status. Families who are unable to pay the program registration fees may be awarded financial assistance based on their income. Scholarships are limited, granted on a first come, first serve basis, and may be limited by the resources available at the time of application.
ELIGIBILITY
1. Applicants must register to participate in a Girls on the Run program being offered at a local school, YMCA, YWCA, Boys and Girls Club and/or church;
2. Assistance will be awarded on the basis of financial need. All applications will be kept confidential as they are specific to individual and family circumstances;
3. Applicants must apply for a scholarship for every time they participate in the Girls on the Run program.
APPLICATION PROCESS
1. Complete the attached application and provide the following documentation:
2. Return your information to Girls on the Run of New Castle County at:
Girls on the Run of New Castle County
P.O. Box 4098
Greenville, DE 19807
3. Attach a copy of your drivers license or a bill mailed to your home address as proof of residence.
4. Your application will be processed within 10 working days. At that time, you will receive notification regarding your scholarship status.
Scholarship Application
GENERAL INFORMATION:
Girl’s Name: ______
Program Location: ______
Parent’s Name: ______
Mailing Address: ______
City/State/Zip: ______Home Phone: ______
Employer: ______
Employer’s Address: ______
Street City/State/Zip
E-mail Address: ______
Marital Status: _____Single ______Married ______Separated/Divorced _____Widowed
Spouse’s Name: ______
Spouse’s Employer: ______
Employer’s Address: ______
Street City/State/Zip
Why do you want to participate in this program? (This question should be answered by the young girl who wants to be in Girls on the Run!)
Scholarship Application (page 2)
INCOME INFORMATION:
1. What is the number of all dependents, living in your household, which you claim on your federal tax return: ______
Combining ALL salary and wages and including ALL sources of income:
2. What is your total monthly income for your household? ______
3. What is your total yearly income for your household? ______
4. List and document any special circumstances that contribute to your request for financial assistance.
5. Girls on the Run of New Castle County believes a strong sense of pride and ownership is developed if the financial assistance recipient has contributed to the cost of their involvement. Therefore, applicants will be asked to pay a minimum of $5 of the program fees. All program fees are kept confidential, as they are specific to individual and family circumstances, and are reviewed each session of Girls on the Run. What is the amount in addition to the $5 are you able and/or willing to pay for the program?______
6. Girls on the Run of New Castle County is fortunate to have donors who support our scholarship fund. Therefore, we feel it is important for you to understand the significance of being awarded a scholarship and that you respect this honor. Failure to do so will result in elimination from future GOTR programs. Please read the following and sign if you agree to abide by these scholarship guidelines:
If awarded the scholarship, do you agree to fully participate in all the scheduled GOTR activities?
Signature of Girl: ______
Signature of Parent/Guardian: ______
Scholarship Application (page 3)
If awarded this scholarship, do you agree to complete the entire GOTR session and participate in the designated GOTR race?
Signature of Girl: ______
Signature of Parent/Guardian: ______
Parent/Guardian: By signing this document, I certify that the information contained in this application is accurate and truthful:
Signature: ______
Date: ______
FOR OFFICE USE ONLY: DATE RECEIVED: ______AMOUNT PAID: ______
DATE CONTACTED: ______BY ______MAIL: ______E-MAIL: ______
PHONE: ______
Calling Parents, Grandparents, Aunts and Uncles …
Run the Girls on the Run 5k in May!
We'd love to see you on the 5k course with your Girl on the Run in May! And we promise you a rewarding (maybe even life-changing) experience, especially if you train smart and prepare for race day. Our friends at the Delaware Running Company have prepared a 9-week training program, combining walking, jogging and inspiration. It's designed for non-runners to slowly and safely prepare to complete their first 5k, and it's a plan you can fit into a busy schedule. We want to see you cross the finish line at the 5k on May 31, beaming with pride just like all the Girls on the Run!
To print a the Delaware Running Company 5K training plan please visit the Girls on the Run website at http://www.girlsontherunde.org
On Saturdays during the 9-week training schedule, join other Girls on the Run families and a Girls on the Run coach for group walk/runs in Rockford Park in Wilmington. Meet at 9:00 a.m. in front of Rockford Tower.
PO Box 4098 Wilmington, DE 19807 302-893-2222 www.girlsontherunde.org