Inspiring Girls to Achieve and Succeed!
Note: This form can only be completed by parents or legal guardians. Child participants in Caring & Sharing programs are NOT allowed to complete this form. Parents or Guardians will be contacted to verify their approval prior to the child's attendance at meetings or activities.
*First Name: *Last Name:
*Age: *Date of Birth:
*Address Information:
*Street Number: *Street Name:
*City: *State: *Zip:
Phone Numbers:
*Primary: - Student Cell Phone: -
Email:
*School Name: *Grade:
*What school activities do you participate in?
*What school subject(s) challenges you the most? Select One English Math Science Social Studies Other
*How did you learn about our program? Select One Flyer Newspaper Parents Referral - counselor Referral - friend/family Referral - judicial related Referral - volunteer Website Word of mouth
*Mother/Guardian First Name: *Last Name:
*Employer: *Primary Phone: -
Alternate Phone: - Email:
*Father/Guardian First Name: *Last Name:
*Student is under the custodial care of: Select One Both Parents Father/Guardian Only Mother/Guardian Only Other
Caring & Sharing Membership Fee is sixty dollars ($60) for six months, or one hundred dollars ($100) for one year. The Membership Fee is payable at the first meeting, or event, whichever is first. By submitting this form the custodial parent/guardian of the minor identified in the Membership Information section of this application, agrees with the policies of Caring & Sharing, which are included here.
I have read and agree with the Caring & Sharing policies.
