TruthGirlz Middle School Registration Form

Registrations are open until 1/12/2020 for Spring Semester.  If you participated in the Fall Semester you do not need to re-register.

  • Parent or Guardian should select the middle school that their student attends. And note that the Middle School program begins at 3:15 or 3:30pm and ends at 5pm.
  • Enter parent's number if you do not have a phone.
  • Select the acceptable ways to contact/inform your student
  • Please check all that apply
  • Primary Contact Permission & Information

  • (Parent, Guardian, Care Giver, Custodial Party)
  • Select the acceptable ways to contact/inform Parent or Guardian
  • TruthGirlz Conduct Expectations

    1 - I will conduct myself according to the standards and expectations outlined in Iredell Statesville Schools Student Handbook particularly the: Network/Internet Acceptable Use Agreement Student Behavior Policies Student Code of conduct (Scripture Reference: 1 Peter 2:13-14; Titus 2:7-8; Romans 13:1) ____________________________________________________________________ 2 - I will neither use my cell phone, laptop or other distractions nor create other distractions during TruthGirlz meetings. (Scripture Reference: 1 Cor 7:35, Col 3:2) ____________________________________________________________________ 3 - I will give others the same respect I would like them to give me. (Scripture Reference: Mark 12:31, 1 Peter 2:17, Matt 7:12) ____________________________________________________________________ 4 - I will be a healthy example to others in how I speak, behave and present myself. (Scripture Reference: Timothy 4:12, Eph 4:29) ____________________________________________________________________ 5 - I will show love to the world around me with actions and truth. (Scripture Reference: 1 John 3:18, Romans 13:10) ____________________________________________________________________
  • TruthGirlz Response Plan

    1 - Review TruthGirlz expectations with Mentor and give verbal apology (if relevant) (Scripture Reference: James 5:16) ____________________________________________________________________ 2 - Review TruthGirlz expectations with Mentor; Solution Session with Family*; written apology as relevant; email to notify parent. (Scripture Reference: Proverbs 14:9 Matthew 18:15-16) ____________________________________________________________________ 3 - Review TruthGirlz expectations and Solution Plan with Mentor; Support Meeting with Family*, Mentor and Site Coordinator; Verbal and Written apology as relevant; parent notification; Restart Points. (Scripture Reference: 1 Thessalonians 5:11, Hebrews 12:14) ____________________________________________________________________ 4 - Review TruthGirlz Expectations /Reevaluation of Solution Plan; Support Meeting with Family*, Site Coordinator, Parent; Loss of Boutique Privilege. (Scripture Reference: Luke 17:3) ____________________________________________________________________ * FAMILY is a TruthGirlz term for our student accountability teams ________________________________________________________
  • Confidentiality Policy of The Pregnancy Resource Center of Statesville

    The Pregnancy Resource Center of Statesville will hold in strict confidence all the information provided to them except as required by North Carolina State Law or when necessary to protect other or clients against a threat of harm: in the professional's judgement, they feel the client is likely to do serious harm to themselves or others; abuse or neglect of children, elderly or any defendants; they are ordered by the court to provide information; the client gives specific written permission. ****** Disclosure Statement ****** When disclosure is required, only information that is essential will be revealed. The client will be informed of such disclosure to other agencies.
  • Please check all Permission Statements that you agree with (all are required for your student/child to participate in the TruthGirlz program)
  • I acknowledge that I have read, understand and agree with all the above statements.
  • Please check all Permission Statements that you agree with (all are required for you to participate in the TruthGirlz program)
  • I have read, understand and agree with the TruthGirlz Expectations, Response Plan and Confidentiality Policy. My signature is my commitment to the TruthGirlz Expectations.
  • Alternate Contact Information

  • (the next person to call if the Primary Contact cannot be reached)