Women of Grace Ministries

One on One Second To None Mentoring

Parental/Guardian Permission

Please print the following information

_________________________________________       _____________________________

   ^{Name of Teen Girl                                                                                    Date of Birth}

 _________________________________       _______________    ________    __________

               ^{Address                                                                   City                                            State                Zip Code}

_____________________________       _____________________________

          ^{Home Phone                                                                Cell Phone}

 ____________________________________     _____________________________________      

                                                             ^{Name(s) of Parent/Guardian and relationship to teen}                                                                                                     

_________________________________       _______________    ________    __________

            ^{Address if not same as above                                               City                          State                   Zip Code}

_______________________      _______________________

^{Home Phone                                                       Cell Phone}

I give permission for  _______________________________,  to participate in the One on One Second to None Mentoring Program
with caring Christian women who have been carefully selected and specially trained to assist teen girls in making positive choices. 

I understand that participation in this program may involve one and/or all of the following:

� Meetings with a Mentor.

� Phone conversations with a Mentor

� Attending workshops

� Setting goals that will assist in future success

� Reading and writing in a journal

� Making and keeping commitments

� Sharing mentoring experiences in writing and speaking, which may at times include pictures or taping,
to encourage other teen girls and/or promote the program

__________________________________________ __________________________

 Signature of Patent/Guardian              Date

 
Please mail to: P.O. Box 1001, Fremont OH 43420

Office locations: 416 W. State St. Suite 202, Fremont, Ohio 43420   Phone: 419-332-1001 www.womenofgraceministries.org