2021 Application

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2021 Application

Girls Inc. CYD Registration

Parent/ Guardian Name *

Child's Full Name *

Child's Date of Birth *

YYYY

Have they participated in Girls Inc. programming during 2020? *

Yes

If they have participated in Girls Inc. programming during 2020, please specify the location.

Primary Language Spoken at Home *

English

Spanish

Chinese

Vietnamese

Other

Particpant's Race *

Asian / Pacific Islander

Black / African American

Latinx/Hispanic/Latin American

Native American / American Indian

Caucasian

Multiracial

Prefer Not to Answer

Other

Required

Ethnicity

Latinx/Hispanic/Latin American

Not Latinx/Hispanic/Latin American

Option 3

Clear selection

Address *

Household Type *

Father Only

Mother Only

One Parent at a Time (Joint Custody)

Other

Unknown / Unavailable

Family Income *

Less than 10,000

10,000 - 20,000

20,000 - 30,000

30,000 - 50,000

Greater than 50,000

Phone number: *

Alternative Contact & Phone Number: *

School Name *

Grade Level going into Fall 2020 *

Youth's T-Shirt Size: *

Allergies?

Media Release: Girls Inc. of Tarrant County will use photographs of the children in agency publications such as brochures, website, and flyers. Your child’s photographs will not be used or sold to any other agencies. If you do not want your child’s photo to be used, please submit a signed letter stating your denial of permission. Please review and check all the following boxes. *

My child may be photographed or recorded.

Required

Participation Release: In an effort to continuously serve Girls Inc. participants, we are providing distance-based, virtual programming from which Girls Inc. staff will facilitate through online platforms. Girls Inc. will use software, tools, and applications provided by third parties that Girls Inc. participants, parents/guardians, and/or staff will access via the Internet and use for purposes of communication and programming. These platforms include: Zoom. As a legal guardian, I give permission for the registrant to participate in all virtual camp activities. I understand that for my child to participate, we must have the technology to attend workshops via Zoom. Participants are encouraged to be under parental supervision while participating in virtual activities. I further agree that Girls Inc. of Tarrant County reserves the right to terminate the participation of my child in the program for failure to behave in accordance with regulations on conduct, or for failure to follow the instructions of supervisors deemed to be detrimental to the interest, comfort, or welfare of the program. PLEASE check ALL boxes below as an electronic signature. *

My child may participate in online programming.

I have reviewed online safety with my child.

I agree to all terms listed above. By checking here I provide my electronic signature.

Required

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