GIRL$ MOVE with Purpose

1. GIRL$ Program Registration

50% of survey complete.

This registration is for the GIRL$ MOVE! program that focuses on helping girls to set goals, gain greater confidence and self-esteem, develop a more positive view of their bodies, and gain greater decision making skills.

Registration is required.

Saturday, January 24, 2015
10:30 a.m. – 1:30 p.m.
Villages at Carver Family YMCA
1600 Pryor Road, SW
Atlanta, GA 30315

Question Title

* 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