Parent(s)/Guardian(s)

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

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* 1. Name of Person Completing this Form:

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* 2. Participant's Full Name

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* 3. Participant's Date of Birth

Date

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* 4. Primary Guardian's Full Name

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* 5. Relationship to Participant:

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* 6. Home Address

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* 7. Guardian Contact Info

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* 8. Participant T-shirt Size

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* 9. Grade (2023 - 2024)

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* 10. Will participant have a relative in camp?

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

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

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

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

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* 15. Please choose one mandatory, in-person parent orientation to attend: 

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

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 Tuesday, June 20th - Wednesday, July 14th (with no camp on July 4th). I also understand that she may only be absent twice during the 4 week camp.

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* 17. Electronic Signature

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

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