Parent(s)/Guardian(s)

This segment is to be completed by the parent(s)/guardian(s).
* = required

Question Title

* 1. Participant's Full Name

Question Title

* 2. Participant's Date of Birth

Date

Question Title

* 3. Primary Guardian's Full Name

Question Title

* 4. Relationship to Participant:

Question Title

* 5. Home Address

Question Title

* 6. Guardian Contact Info

Question Title

* 7. Participant T-shirt Size

Question Title

* 9. Will youth have a relative in camp?

Question Title

* 10. If YES to the question above, name of relative in camp: 

Question Title

* 11. Has youth participated in Girls Inc. Program(s)?
(Select all that apply)

Question Title

* 12. If YES to the question above, please provide the name of the school site.

Question Title

* 13. Choose the camp that your daughter will attend (choose one):

Question Title

* 14. There is a ONE-TIME registration fee (per household): $25 for one girl and $10 each additional girl. Choose one payment option below:

Question Title

* 15. Please choose one mandatory parent orientation to attend: 

For Guardians and Participants together, please read and sign below:

We understand the commitment required for the Concordia summer camp. If we are selected to join the program, we agree that our participant will attend every day, Monday-Friday, during the 4-week period from June 20th - July 15th (with no camp on July 4th). I also understand that she may only be absent twice during the 4 week camp.

Question Title

* 16. Electronic Signature

Questions? Please contact Virgtrese, Program Manager @ vmcgee@girlsinc-alameda.org

T