Self-Esteem

Participant Information

Participant's First and Last Name*

First Last

Participant's Date of Birth mm/dd/yyyy*

Participant's grade level in Fall 2020*

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

My daughter identifies as:*

Check all that apply
NOTE: This data is collected for official agency reports.

Asian
Black/African
White / Caucasian
Hispanic/Latinx
Native American
Pacific Islander
Prefer Not to Answer
Other

Please select a t-shirt size*

List any allergies or dietary restrictions

Parent/Legal Guardian

Parent/Guardian's Name*

First Last

Parent/Guardian's Email Address*

Enter Email Confirm Email

Parent/Guardian's Phone Number*

Parent/Guardian's Contact Phone Number (2nd option)

Billing Address

Street Address Address Line 2 City State ZIP Code

Emergency Contact

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

Camp Information

How did you hear about the virtual camps?*

Select which camps you are registering for:

Jeopardy: June 24th
Self-Esteem: July 8th
Chalk Paint Art July 15th
Healthy Cooking Session July 22nd

Review and check the following boxes.*

My child may participate in all camp 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. girls, 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. girls, 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 daughter.

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.

Self-Esteem

Self-Esteem
Wednesday July 8th, 11:30 pm – 12:30pm
For girls in grades 6th-8th

Via Zoom

Participant Information

Parent/Legal Guardian

Emergency Contact

Camp Information

Self-Esteem

Self-Esteem Wednesday July 8th, 11:30 pm – 12:30pm For girls in grades 6th-8th

Via Zoom

Participant Information

Parent/Legal Guardian

Emergency Contact

Camp Information

Welcome back,

Self-Esteem
Wednesday July 8th, 11:30 pm – 12:30pm
For girls in grades 6th-8th