Copy of Girls' Club Registration

Registration is $30 to secure your child's spot.

Child Name

Child's Date of Birth

Child Age

Primary Parent Name

Parent Name (Secondary)

Address

Emergency Contact (1) Name

Emergency Contact (2) Name

Child's Grade

Primary Phone Number

Parent Phone Number (Secondary)

Emergency Contact (1) Phone Number

Emergency Contact (2) Phone Number

Non-Parent Pick Up Authorization

Known Allergies

Is the participant on medication?

Yes

If yes, what medication are they taking?

Does the participant require support/accomodations due to a disability?

Yes

If yes, please download Particpant Information Form and upload it here.

Upload Form

File Size (Max 15MB)

I hereby certify that the information provided is true and to the best of my knowledge.

Your Signature

Today's Date

Parent & Participant Handbook