Name: High School Workshops
Start: 2020-08-18
End: 2021-05-19
Location: Virtual

Please fill out the form completely.

Participant Information

Participant's Name*

First Last

Participant's Date of Birth*

Participant’s Gender*

Male
Female
Other

Participant's School in Fall 2020*

Participant's Grade Level in Fall 2020*

Home Address*

Street Address Address Line 2 City State ZIP Code

Have they participated in Girls Inc. Programming during 2020?*

Yes
No

If 'Yes' Please specify location

Primary Language of Participant*

English
Spanish
French
Other

Household Type*

Father Only
Mother Only
Two Parents
One Parent at a Time (Joint Custody)
Other
Unknown/Unavailable

NOTE: The data collected in the following questions are for official agency reports.

Family Income*

Less than $10,000
$10,000 – $20,000
$20,001 – $30,000
$30,001 – $50,000
Greater than $50,000
Unknown/Unavailable

Participant's Ethnicity*

Latina/Hispanic/Latin American
Not Hispanic/Latina/Latin American

Participant's Race*

Asian American/Pacific Islander
Black/African American
Hispanic/Latina/Latin American
Native American/American Indian
White/Caucasian
Multiracial/Mixed Heritage
Prefer Not to Answer
Other

Please Select a T-Shirt Size*

List any allergies or dietary restrictions

Parent/Legal Guardian Information

Parent/Guardian Name*

First Last

Parent/Guardian Email Address*

Parent/Guardian Phone Number*

Parent/Guardian Name (2nd option)

First Last

Parent/Guardian Phone Number (2nd option)

Address*

Street Address Address Line 2 City State ZIP Code

Emergency Contact Information

Who should be contacted in the event of an emergency if a legal parent/guardian cannot be reached?

Emergency Contact Names and Phone Numbers*

Please list 2 names and contact numbers. Please list how the emergency contacts are related to the child. Example: John Smith, Uncle, (123)-456-7890

Program Information

How did you hear about the virtual programming?*

Select which programs you are registering for:*

Middle School Programming grades 6th-8th
High School Programming grades 9th-12th

Media Release
Girls Inc. of Tarrant County will use photographs of the children in agency publications such as brochures, website, and flyers. Your child’s photographs will not be used or sold to any other agencies. If you do not want your child’s photo to be used, please submit a signed letter stating your denial of permission.

Review and check the following boxes.*

My child may participate in all program activities.
My child may be photographed and/or recorded.
I have reviewed online safety procedures with my daughter.

My child may access virtual programming through online platforms. In an effort to continuously serve Girls Inc. participants, we are providing distance-based, virtual programming from which Girls Inc. staff will facilitate through online platforms. Girls Inc. will use software, tools, and applications provided by third parties that Girls Inc. participants, parents/guardians, and/or staff will access via the Internet and use for purposes of communication and programming. These platforms include: Zoom. Please provide consent for your child to utilize these applications for distance-based, virtual program purposes. Please be aware that each application collects different information about its users and has its own privacy terms and conditions to which you must adhere. Please review these carefully before registering your child.

As a legal guardian, I give permission for the registrant to participate in all virtual camp activities. I understand that for my child to participate, we must have the technology to attend workshops via Zoom. Participants are encouraged to be under parental supervision while participating in virtual activities. I further agree that Girls Inc. of Tarrant County reserves the right to terminate the participation of my child in the program for failure to behave in accordance with regulations on conduct, or for failure to follow the instructions of supervisors deemed to be detrimental to the interest, comfort, or welfare of the program. If participation is terminated, fees will not be reimbursed.*

By checking here, I (parent/legal guardian) agree to the terms above. This check serves as the electronic signature of the parent/guardian.

For additional information, please call Karina Diaz at (817) 259–1050 or email [email protected]

Date

Time

High School Workshops

Workshops for High School
Wednesday
4:45 PM – 5:45 PM
For girls in grades 9th-12th
Via Zoom

Participant Information

Parent/Legal Guardian Information

Emergency Contact Information

Program Information

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Location

Date

Time

High School Workshops

Workshops for High School Wednesday 4:45 PM – 5:45 PM For girls in grades 9th-12th Via Zoom

Participant Information

Parent/Legal Guardian Information

Emergency Contact Information

Program Information

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Location

Welcome back,

Workshops for High School
Wednesday
4:45 PM – 5:45 PM
For girls in grades 9th-12th
Via Zoom