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Girls’ Leadership Council

Participation and Photo Release (Minor)

Date: __________________

Member’s Name: _________________________________________________________ Age: ____________________

Participation in Girl’s Leadership Council Activities

I hereby grant permission for my child to take part in Girl’s Leadership Council (GLC) activities presented by the Delores Barr Weaver
Policy Center (DBWPC.)
 I understand that Girls Leadership Council meetings typically include presentations on careers and professional development by
volunteer professionals, college students, and community leaders, and that meetings may also include lunch and snacks,
information about DBWPC services, craft projects, time outdoors, and other activities as requested by the members.
 I understand that GLC meetings are held at the Pink House, located at 626 May Street, Jacksonville FL 32204, and that the Delores
Barr Weaver Policy Center does not provide transportation to and from meetings unless specifically stated in a field trip flyer
 I understand that GLC activities are offered free of charge to members and their guests
 I understand that I will be asked for separate permission for my child to participate in field trips and special activities that take
place offsite
GLC welcomes all girls and young women ages 12-21, and those who identify as girls and young women. The Delores Barr Weaver
Policy Center does not discriminate on the basis of race, age, color, sex, religion, national origin, gender, sexual orientation, gender
identity, gender expression, marital status, age, veteran status, physical or mental disability, or otherwise as may be prohibited by
federal and state law.

Parent/Legal Guardian Name: ___________________________________________________________________________

Signature: ___________________________________________________________________________________________

Cell phone: _________________________________________ Email: ___________________________________________

Street Address: _______________________________________________________________________________________

City, State, Zip: _______________________________________________________________________________________

Standard Photo Release (Minor)

I hereby authorize the Delores Barr Weaver Policy Center to publish photographs and/or videos taken of the undersigned minor child
(children) for marketing materials. Such materials include printed pieces (brochures, newsletters, flyers, etc.), use of photographs for
the Policy Center's website ( and social media, as well as in presentations. Note that the Policy Center does not
identify minor children by name without separate parental/legal guardian consent.

I allow the Policy Center to use photography of the above named minor and attest that I am the parent or legal guardian of the child
listed above and that I have the authority to authorize the Policy Center to use their photographs, videos.

I acknowledge that since participation in publications and websites produced by the Policy Center is voluntary, neither the minor child
nor I will receive financial compensation.

I further agree that participation in any publication and website produced by the Policy Center confers no rights of ownership
whatsoever. I release the Policy Center, its contractors and its employees from liability for any claims by me or any third party in
connection with my participation or the participation of the undersigned minor children.

Parent/Legal Guardian Signature: ___________________________________________________________________________