Jewel application
Please fill out the below form to start your journey to becoming a Jewel. We advocate in bridging the gap between love and community care and we also provide a safe space for girls of all ages to be themselves. for all questions please contact (904) 701 - 8804
Future Jewel First Name
Future Jewel Last Name
Parents first and last name
Parents Phone Number
Parents Email
Future Jewels Phone Number
Future Jewels Email
Where do you attend school?
When is your birthday?
Do you have any dietary restrictions?
Is there anything you would like us to know? Nothing is too big or small!
Do you express or need help with any of the following?
Depression
Anxiety
Anger management
Bullying
Suicidal thoughts/Attempts
I'm ready to shine!
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