Good Life Male Leadership Alliance Application

Question Title

* 1. Applicant Information

Name

Grade

Birthdate

Address

City

State

ZIP Code

Email Address

Phone Number

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* 2. Parent/Guardian 1 Information

Name *

Address

City

State

ZIP Code

Email Address *

Phone Number *

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* 3. Parent/Guardian 2 Information

Name

Address

City

State

ZIP Code

Email Address

Phone Number

Question Title

* 4. School Information

School Name *

Principal's Name

Address

City

State

ZIP Code

Email Address

Phone Number

Question Title

* 5. I, the undersigned parent/legal guardian of the child named below, hereby consent to and give my permission for the following, the member:

-Has my consent and permission to participate as a member of the Family Wellness Outreach Center of Georgia, Good Life Male Alliance
-Has my consent and permission to participate in all Good Life Male Leadership Alliance activities, which may also include activities held at other locations.
-Will be participating at her own risk and I, on his/her and my own behalf, hereby release, discharge and indemnify Family Wellness Outreach Center of Georgia, and its subsidiaries from all liability for injury to person or damage to property of myself and the Member arising out of participation in, and transportation associated with, Good Life Male Leadership Alliance
-Grants permission to Family Wellness Outreach Center of Georgia and the Good Life Male Leadership Alliance to use the likeness, voice and words of the Member in television, radio, films, newspapers, magazines and other media, and in any form not heretofore described, for the purpose of advertising or communicating the purposes and activities of the Girl Power Inc. and appealing for funds to support such activities.

*In the event of an accident or illness during Good Life Male Leadership Alliance activities, I understand that reasonable effort will be made to contact the parent/guardian or emergency contact immediately. However, I am aware that if the injury or illness appears serious and the parent/guardian or emergency contact cannot be reached, the adult in charge will secure emergency medical care as needed.

By signing below, you affirm that you have read and agree to the expectations and guidelines of the Family Wellness Outreach Center of Georgia Good Life Male Leadership Alliance.

Child's name

Guardian's Name

Date

Question Title

* 6. Dear Potential Good Life Male Leadership Alliance,
As a GLM member, you will learn to:
• The Importance of Male Leadership in the community.
• The Importance of Academic Achievement.
• The Importance of Mental Health Awareness.
• The Importance of having a Life Success Plan.
• The Importance of career readiness and higher education.
As part of this group, you will:
• Attend all Good Life Male Leadership Alliance Sessions.
• Provide feedback on program success and goals upon completion of the program.
• Serve as a Representative of the Sexual Risk Avoidance Education and unplanned Teen Fatherhood reduction mission.
• Represent Family Wellness Outreach Center of Georgia at various national, state and local conferences as well as press/media functions.
•
*The Family Wellness Outreach Center of Georgia Good Life Male Leadership Alliance is at-will and participants may be dismissed at the supervisor’s discretion due to failure to meet responsibilities.

By signing below, you affirm that you have read the above expectations and guidelines, and agree to work, if selected, toward achieving these expectations and responsibilities for the duration of your participation in the Good Life Male Leadership Alliance.

Name

Date

Question Title

* 7. Code of Conduct
Good Life Male Leadership Alliance understand that the organization requires the highest standards of behavior. The Good Life Male Leadership Alliance member agrees to conduct himself in a manner that contributes to a sense of community among all students and forum staff and foster an atmosphere of mutual respect.
The Good Life Male Leadership Alliance member agrees to the following code of conduct:
1. Behavior at all times should be such that it respectfully reflects Family Wellness.
2. Council members are expected to exhibit trustworthiness, respect, responsibility, fairness, and citizenship.
3. As such, uses of tobacco, alcohol, or other illegal substances are not acceptable for Members. Participation in any of the above may result in automatic termination from the Council.
4. If a Member is found responsible for any criminal or legal offenses, such as stealing, vandalism, harassment, or assault, the member may face automatic termination from the Council.
5. Accidents, injuries, or illnesses that affect attendance for GLM-related activities should be reported to the Council Supervisor as quickly as possible.
6. Inappropriate physical contact with other officers or members is unacceptable.
Responsibilities and Duties
As Good Life Male Leadership Alliance member, you are a representative of your home community as well as your organization. You have been selected because your ideas and your hard work embody our mission. As a result, it is also important to be aware that your actions also reflect on Family Wellness.
The development and success of the organization’s programs and initiatives is affected by your performance in completing duties. As a result, it is extremely important to attend all meetings, to let us know in advance if you are unable to attend meetings and to be punctual. Your fellow members will also rely on you to provide help and support.
As a Good Life Male Leadership Alliance member, you are a role model to other youth who want to be leaders in their communities, just like you. This is an opportunity and a challenge to practice important leadership skills, and to guide and inspire other future leaders. The example that you set, through your motivation, your energy, and your commitment, will affect not only your fellow Good Life Male Leadership Alliance members, but also our engagement with youth around the country.

Member Responsibilities:
• Regular attendance at Bi weekly meetings
• Attend Forums & Group Discussions
• 10+ hours of community service
• Participate during activities or sessions

You Are Accountable For:
• Timely and good communication
• Managing your schedule
• Working as a team, sharing responsibilities, and working through challenges with others
• Identifying and working with differing styles of leadership and collaboration

I agree to the Family Wellness Outreach Center of Georgia: Code of Conduct and understand that if this conduct is not followed that I will be released from my position on the Girl Power Inc.

Name

Date