2020-2021 PROJECT MALE STUDENT REGISTRATION FORM

June 1, 2020

Hello Parent/Guardian:

Project MALE's Program Year is October - May. To register your son (or sons) for Project MALE for Program Year 2020 - 2021, please complete the attached form.   Please answer ALL questions.  If the question does NOT APPLY to you or your child, write NA in the box.

By registering your child, you agree that your child will:

--  Be in attendance and on time for each session.
--  Be prepared for each session.
--  Follow instructions and will be on best behavior during sessions.

By registering your child, you agree that you will attend with your child whenever possible.

If you have questions or need further clarification, please reach out to either of the persons listed below.

Thank you for your interest in Project MALE.

PROJECT MALE PLANNING COMMITTEE MEMBERS:
Odell L. Brown, odellbrown72@gmail.com, 214-212-9374
Dr. Jennifer Wimbish, jbwimbish@yahoo.com, 469-826-9108
Carole Mayo, clmayo44@yahoo.com, 972-386-0596
(Note: Project MALE also partners with the EMBODI group of the Dallas Alumnae Chapter of Delta Sigma Theta Sorority.)


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* 1. Today's Date

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* 2. Student's Name (First and last)

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* 3. Student's Home Address:

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* 4. For Child #1, please give...:

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* 5. For Child #2, please give...:

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* 6. Parent's/Guardian's Information:

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* 7. EMERGENCY PICK UP AUTHORIZATION:  I authorize the person listed below to pick up my child from the Project MALE Program. For my child's safety, I understand that any authorized person on the list below will be asked to show photo identification before my child is released to them; therefore, I will notify all authorized persons of this requirement so that they will have photo identification with them when they arrive to pick up my child.

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* 8. Is there anything else you wish to add?

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