Enchanted Closet, Inc.

1. June 18, 2011 GIRL$ Service-Learning Program Registration

50% of survey complete.

This registration is for Pretty, Poised, and Prepared for Unlimited Possibilities: Self Awareness and Self Esteem Program and the GIRL$ READ! Book Club Meeting on June 18, 2011.

Girls and women, who are not parents of the girls in attendance, are required to register.

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* 1. This section is for girls 12-19 years of age.
Please complete the registration survey. Your name and other identifying information will not be provided to anyone not affiliated with the Enchanted Closet, Inc. Please make sure your email address is correct so that we may confirm your registration and send you information as necessary. A registration survey MUST be submitted for EACH person even if you are attending as a group. We must collect and report certain statistics to our donors.

Name

Email address

Phone number

Grade

Age

Race

School

Youth Group Name/Leader's Name

If attending with a group, please provide the leader's email address

Emergency Contact Number

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* 2. Would you like to register for the GIRL$ READ! Book Club also?

Yes

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* 3. If yes, please provide a mailing address where we may send your book, if necessary.

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* 4. Do you enjoy reading?

Yes

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* 5. How many books do you read a month?

more than 4

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* 6. Do you feel that reading is important?

Yes

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* 7. Do you keep a journal of your thoughts?

Yes

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* 8. I am a woman over 19 years of age?

Yes