Please fill out the form completely.
Date Format: MM slash DD slash YYYY
Emergency Contact Information
Who should be contacted in the event of an emergency if a legal parent/guardian cannot be reached?
Is anyone in your family an active member of the military? If so, Who? (Ex. Mom, Dad, Cousin, etc.)
Girls Inc. of Tarrant County will use photographs of the children in agency publications such as brochures, website, and flyers. Your child’s photographs will not be used or sold to any other agencies. If you do not want your child’s photo to be used, please submit a signed letter stating your denial of permission.
Consent to Transport
I give permission for my child to be transported by Girls Inc. of Tarrant County. I understand that Girls Inc. of Tarrant County will transport my child to and from the location. I release Girls Inc. of Tarrant County from all liability for any adverse results that may occur. I agree to release Girls Inc. of Tarrant County and its employees and officers from all liability with reference to the above-stated transportation.
For additional information, please call Karina Diaz at (817) 259–1050 or email [email protected]