#100GL Summit Individual Registration Form
Summit 2023: Day of Interactive Mentorship for Girls (#100GirlsLeading2023) is a one-day event for interactive mentoring for girls ages 9-18. It will be hosted on May 27, 2023 at 1:00-5:00 PM at the McLevy Green Park at 999 Broad Street, Downtown Bridgeport, CT 06604. Girl(s) attending Summit 2023 MUST be accompanied by ONLY a female adult (18 or older). No girl will be allowed on the ground unless accompanied by a female adult. (NO MEN ARE TO BE ON GROUNDS DAY OF EVENT).
Sign in to Google to save your progress. Learn more
Email *
Child's First Name: *
Child's Last Name: *
What school does your child attend: *
Parents Preferred Phone Number *
Parents First and Last  *
Address/City  *
Is your daughter currently in mentorship program  *
Required
What is our child's interested in  (Please check all that apply). *
Required
Please provide your ethnicity and race below. *
Required
How did you hear about #100GirlsLeading2023? *
Girl(s) attending Summit 2023 MUST be accompanied by ONLY a female adult (18 or older). No girl will be allowed on the ground unless accompanied by a female adult. (NO MEN ARE TO BE ON GROUNDS DAY OF EVENT). Please choose "yes" to agree with this statement. *
We want to Advise Every Parent and Guardian that PICTURES will be taken during the event.  *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms