Girl Empowerment Intake Form
Subject Age and Grade Level
Session Date / Time
Please tell us a little bit about her extra cirricular activities she enjoys (dance, riding, art, voluneer work etc)
Please tell us of any challanges she has faced or is facing ( Health issues, Mental Health Issues, Bullying, Cut from a team etc)
Do you have any specific concerns or challanges with your daughter?
Any other comments etc?