Girls RAP

Girls RAP Permission Form

Girls RAP is an empowerment program that support girls ages 12-18 with navigating girlhood and building healthy relationships. Programming is offered within five partner schools and on-site at YWCA Downtown. The school-based Girls RAP programming include twice-weekly group sessions and academic-related support. They are held during the school day preferably during non-instructional times. The schedule is determined with the support of the school leadership.

YWCA site-based Girls RAP program include once-weekly group sessions, meals and transportation provided and individualized case management. Youth are assigned a case manager that support them in framing and achieving their personal goals. Once a youth completes school-based or YWCA site-based Girls RAP programming, they are enrolled in aftercare support for one year. They are invited to YWCA Minneapolis to engage with program staff and enrichment opportunities.

Fill out the form below to register youth for this program. Questions? Contact DaVonna Rucker at drucker@ywcampls.org or 612-215-4123.

Return to Girls RAP Complete Participant Information Form

Girls RAP Permission Form

Youth Information
Youth's Name*
First Last
Select the program you are registering for
Parent/Guardian Name
Name*
First Last
Email*
Phone*
Relationship to Applicant*
Parent/Guardian Consent
Read the following statement and fill out the form completely.
Consent*
I agree to the following statements.
I hereby permit my child to participate in all activates of the Girls RAP program. I hereby certify that my child, to my knowledge, is capable of participating safely in the educational, athletic and recreational programs of Girls RAP. I understand the arrangements and believe the necessary precautions and plans for the care and supervision of my child during the programming will be taken. Beyond what is outlined in the other sections, YWCA staff or program staff will not be liable for occurrences in the groups.

1. I grant permission for my child/ward:
- To participate in all activities of YWCA youth programs
- To participate in program field trips under proper supervision
- To ride in authorized YWCA vehicles for program activities
- For the YWCA Youth Program Counselor to obtain information on my child’s/ward’s academic and attendance records

2. I understand that programs may contain information on sexuality and other health-related issues and I give my
child/ward permission to participate.

3. I agree that neither YWCA nor any other person associated with them has any responsibility to me or to my
child/ward for any claims arising from accident, health or medical treatment.

4. I understand that any expenses incurred under item 3 will be the sole responsibility of the child’s/ward’s family.

5. I understand that YWCA staff and volunteers are Mandated Reporters. If abuse or neglect is suspected, YWCA staff
and volunteers are required by Minnesota law and YWCA policies to place a report to Child Protection Services.

6. I will NOT hold YWCA Minneapolis responsible for any personal property that is lost or stolen during participation.

7. Should any injury occur to my child during participation in said program, I authorize Girls RAP to arrange for or provide emergency medical treatment and arrange for or provide transportation to the nearest qualified medical facility.

8. I grant permission for medical personnel to act as judgement dictates, in case emergency care is needed for my child.
Parent/Guardian Signature*

By typing my full name in the box below, I consent to the above. This is equivalent to my signature.
Date*
MM slash DD slash YYYY
Publicity Consent
Consent
I hereby grant voluntarily and without monetary compensation the YWCA of Minneapolis permission to:
- Make video and audio recordings of me and/or my voice.
- Take and use photographs of me and/or my family.
- Record, use, display and disclose in a video and/or other media intended for public consumption statements and/or information provided by me concerning myself and/or my family.
- Use the activities listed above for direct mail, advertising, public relations, website, email, social media (e.g., Facebook, Twitter, etc.) and other online efforts related to the YWCA of Minneapolis.
- Use my name and the names of members of my family in conjunction with the activities listed above.

With respect to the above, I relinquish to the YWCA of Minneapolis all rights, title and interest I may have in all originals, edited versions, reproductions, and copies of any video and/or audio recording(s), prints, negatives, digital images and photographs in which my or members my family’s name, image, statements, information, and/or voice is used (the “Materials”).

I also irrevocably grant the YWCA of Minneapolis permission to copyright, if applicable, the Materials, and to use, reuse, copy, publish, display, exhibit, reproduce, license to a third party, and distribute the Materials in any manner and for any reason the YWCA of Minneapolis may deem proper, including the right to use the same for purposes of advertising or trade.

By signing this Publicity Consent Release, I acknowledge that the YWCA of Minneapolis is not responsible for the
unauthorized use of the Materials by unrelated third parties. I hereby release the YWCA of Minneapolis from liability for any damages that may arise from the unauthorized use of the Materials by a third party.

NOTE: If you should no longer like the YWCA of Minneapolis to use your image in its awareness and education materials and activities, please contact the YWCA of Minneapolis. Due to the distribution and printing timelines, some of the materials the YWCA of Minneapolis may not be able to remove your image immediately from its pieces, but will do so as soon as those print pieces are scheduled for reprinting or new production. Print materials that are distributed to public audiences may not be recalled once distributed. Materials used for emails, website, social media or other online efforts may be removed from YWCA sites and networks, but due to the nature of the internet, may remain available online through other sources indefinitely.
Youth Name
Parent/Guardian Name

By typing my full name in the box below, I consent to the above for the child(ren) listed. This is equivalent to my signature.
Date
MM slash DD slash YYYY
Attendance and Youth Agreement
All youth and expected to attend and participate in programming throughout its 10-week duration. Absences must be communicated to program staff. Youth are expected to attend group session on time and will not be permitted to attend programming if more than 15 minutes late. YWCA Minneapolis has zero tolerance for physical fighting and/or threatening behavior. Any youth who engage in an act of violence will be removed immediately.
Youth Signature*

By typing my full name in the box, I consent to the above listed. This is equivalent to my signature.
Parent/Guardian Signature*

By typing my full name in the box, I consent to the above listed. This is equivalent to my signature.
Date
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

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Girls RAP

Girls RAP

Girls RAP Permission Form

Girls RAP Permission Form

Youth Information

Parent/Guardian Name

Parent/Guardian Consent

Publicity Consent

Attendance and Youth Agreement