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Social Media Preoccupation Virtual Support Group for Teenage Girls

*REGISTRATION FORM*

Our group meets on Tuesdays @ 4 pm EST starting May 21, 2024
1.Are you the parent or guardian? (Only the parent or guardian is authorized to register participants in Sisterhood Agenda's girls' programs.)
2.What is your child's first name?
3.What is your child's last name?
4.As the parent/guardian, what is your first name?
5.As the parent/guardian, what is your last name?
6.What is the best email address to use to contact you?
7.What is your child's email address to use for the program?
8.Do you give permission for your child to participate in Sisterhood Agenda's Social Media Preoccupation Support Group for Teenage Girls?
9.The group meets virtually for one hour each week and the participation fee is $70 per week, billed monthly. Is this Payment and Fees Policy acceptable to you?
10.Is there any reason that you can think of, medical, psychological, or other, that your child should not participate in Sisterhood Agenda's Social Media Preoccupation Virtual Support Group for Teenage Girls?
11.Print your full name below to sign and agree to the terms of the program:

Participation Consent and Terms of Agreement
I, the undersigned, hereby release discharge, indemnify, hold harmless, and defend Sisterhood Agenda, Inc., its officers, employees,and servants from any liability (claims, demands, losses, causes of action, suits, judgments) of any kind that I or my family may have against the organization due to death, personal injury or illness, loss or damage to property, or future causes that occur during the program. In the event of any medical emergency, I authorize and consent for Sisterhood Agenda, Inc. to act on behalf of the program participant regarding medical care deemed necessary for her.

The financially responsible party signing this form understands and agrees to the Payment and Fees Policy.

I hereby give permission for my child to be photographed during the program. I understand the photos will be used to keep a journal of activities, to share during PowerPoint presentations and/or reports, and for promotional purposes. I understand that, although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation, and that all photos are the property of Sisterhood Agenda, Inc. and its affiliates.

Sisterhood Agenda, Inc. and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders.
12.Enter today's date.
Date / Time
13.What is your telephone number for emergencies and text messaging?
14.Is there anything else you would like for us to know?
Current Progress,
0 of 14 answered