Voices
(Formerly Girlz Club)
Parent Information
www.voicesofbranchcounty.com
Dear Parent(s) or Guardian(s):
We are pleased to offer your daughter the opportunity to participate in the Voices (formerly GIRLZ CLUB) After School program. You are receiving this application packet because your child’s teacher, coach, counselor, etc. has determined that your child would benefit by participating in this free after-school program. Please read the following program information to determine if you would like your child to participate in the after-school program.
Voices offer girls and young women in grades 4th-8th grade an after-school program that will equip and empower them with the tools necessary to achieve and inspire them to become leaders. This program was developed to provide young girls with the opportunity to learn and develop self- confidence, self-worth and new skills in a safe non-judgmental environment. Each program will be taught by local community members who want to offer their time and knowledge to help youth on their path to becoming confident and successful young girls and young women. Being a member is strictly voluntary. Voices is broken up into two age groups:
The young women in grades 6th, 7th, and 8th will meet each Wednesday beginning October 18th from 2:45 - 4:15 p.m. Girls in grades 4th and 5th will meet each Wednesday beginning October 18th from 4:00 – 5:30 p.m. Voices meets at the Coldwater Free Methodist Church 200 N. Fremont St. (there is no religious affiliation). Girls will be transported by a school bus from Lakeland to Max Larsen and they will be escorted to the church next door. Parents will need to provide transportation home.
An Open House is scheduled for October 4th, 2017 from 5:00 – 6:30 p.m. at the Coldwater Free Methodist Church.
If you would like to enroll your daughter in the program, please complete the attached application and mail it to: Voices 220 N. Michigan Ave. Coldwater, MI 49036 or email it to .
We look forward to a fun and exciting year and hope your child will be joining us! If you have any questions, please feel free to call me at 517/227-2758 or Kim Hemker at 517/278-7233.
Sincerely,
Patsy Karbon
Patsy Karbon,
Program Facilitator
Voices
After School Application
Child’s First Name: Last Name:______
Date of Birth: ____/____/____ School: Grade: ______
Parents or Guardian’s Name(s): ______
Address: ______Home Phone #: ______Email: ______
Mother’s Work Phone # Father’s Work Phone#: ______
Mother’s Cell# Father’s Cell Phone#:______
Person(s) authorized to pick up your child / Emergency Contacts: (Person must show picture I.D.)
Name:______Relationship: ______Phone#:______
Name:______Relationship: ______Phone#:______
Name:______Relationship: ______Phone#:______
Name:______Relationship: ______Phone#:______
Student lives with: ___ Father ____ Mother ___ Step Parents ___ Foster ___ Legal Guardian ___ Other
Primary Language: □English □Spanish □Other:______
Is your child under medical care or taking any medication(s)? □ Yes □ No
If yes, please check all of the following conditions that your child has and indicate if medication needs to be dispensed at school?
□ Bee Sting Allergy Epi-pen □ Yes □ No □ Other Allergies: ______
□ Asthma Inhaler □ Yes □ No □ Special Needs / Disability:______
□ Diabetes Insulin □ Yes □ No □ Other:______
□ Vision / Hearing Glasses □ Yes □ No
Family Health Care: Physician’s Name:______Phone #:______
Address:______Media-Cal: □Yes □ No
Health Insurance# ______
Does the Voices program have permission to use photos of your child in educational or promotional materials? (There is no cost.) Yes:_____ No:______
Please read and sign below:
I understand that the Voices After School Program is a FREE program. These services are possible through community grants and donations.
Parent or Guardian Signature:______Date:______