Register for Fall 2021 Virtual GUTS! Groups!
Thank you for your interest in participating in GUTS! this fall! The GUTS! Program is committed to providing positive group and mentoring experiences for our community, especially our girls and gender-diverse youth. Both participant and parent/guardian will be asked to e-sign this form so please have both parties present before filling this out because answers will not be saved along the way.

We have two groups available to join this session-- one for 4th & 5th graders, and one for 6th-8th graders. Interested participants who identify with girlhood or womanhood are welcome to join any GUTS! programs. This includes participants who are transgender or are outside the gender binary and feel that GUTS! could be beneficial or enjoyable to them. It is the YWCA Missoula's policy to not discriminate against any persons based on race, physical or mental disability, religion, national origin, sex, age, creed, physical condition, sexual orientation, gender identity, or expression.  

If you are filling this form out for more than one participant, please fill out two forms for ease of registration processing, thank you!
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Email *
Participant's Name: *
What school are you attending for the Fall 2021- Spring 2022 school year? Write "home school", "MCPS Online Academy", or the name of the school attending in-person. *
What is the best email for you to receive Zoom links, updates, etc? This can be a parent/guardian or student email address but please note that student email addresses created by the school cannot receive emails from outside of that school's district. *
Grade in school: *
Date of Birth *
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DD
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YYYY
Ethnicity:
Gender:
Please provide an address where we can drop off Activity Kits, so please no PO Boxes if possible. If you are outside of Missoula, we will mail them to you. Street Address (include unit, apartment #, etc). *
City *
State *
Zip Code *
Parent/Guardians' Name(s): *
Parent/Guardians' Phone Number(s). Numbers provided will get weekly reminder texts about groups on the day of your group meeting. *
Student Cell Phone Number (if applicable). This number can also get a weekly reminder text if requested.
Please list any medical/mental condition(s) that your child has that we should be aware of:
How did you hear about GUTS!?
Does your child qualify for free or reduced lunch program?
Clear selection
Does your child have an emotional/physical/mental disability?
Clear selection
If you answered yes to the above question please explain.
Are there any friends you want to make sure are in your group? If you'd like to be grouped with participants from your own school, please indicate so here and we will do our best! If you'd like to stay with your group from the fall, just write what group you were in (i.e. Monday elementary)
Both the participant and guardian will have to sign below: Please read carefully before electronically signing.  This is a release of liability and waiver of certain legal rights. In consideration of my being permitted to participate in the activities of Girls Using Their Strengths (GUTS!) and /or the YWCA Missoula, I agree to the following Waiver and Release.  I for myself, my heirs, successors, executors and subrogees, hereby KNOWINGLY AND INTENTIONALLY WAIVE AND RELEASE, INDEMNIFY AND HOLD HARMLESS GUTS!/YWCA, their directors, officers, agents, employees, and volunteers from and against any and all claims, actions, causes of action, liabilities, suits, expenses (including reasonable attorneys' fees) which are related to, arise out of, or are in any way connected with my participation in this activity including, but not limited to, NEGLIGENCE, of any kind or nature, whether such damage loss, injury, paralysis or death results from negligence of GUTS!/ YWCA or from some other cause I, for myself, my heirs, my successors, executors, and subrogees, further agree not to sue GUTS!/YWCA Missoula as a result of any injury, paralysis, or death suffered in connection with my use and participation in the activities of GUTS!/ YWCA. I agree that GUTS!/ YWCA Missoula may photograph and record my likeness and activities. I grant the following rights to GUTS!/ YWCA Missoula, their agents and assigns: permission to use and re-use, publish and re-publish, and modify or alter the image(s) taken during the shoot. Use of the images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, worldwide in perpetuity for the purposes stated above.I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge GUTS!/ YWCA Missoula and their agents and assigns from any and all claims arising out of use of the images for the purposes described above, including any claims for libel, invasion of privacy or other tortuous act.I HAVE CAREFULLY READ, CLEARLY UNDERSTAND, AND VOLUNTARILY SIGN THIS WAIVER AND RELEASE AGREEMENT.   Participant’s E-Signature (typed name): *
By checking this box, I acknowledge that the electronic signature above constitutes my legal signature. *
Required
If participant is under 18, parent/guardian e-signature (typed name).
By checking this box, I acknowledge that the electronic signature above constitutes my legal signature.
Date E-Signed
Do you have any questions about the upcoming semester of GUTS! groups? Jess, the GUTS! Program Coordinator, will reach out to you to answer any questions submitted here. Thank you!
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