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Bay Area Girls Club Program Registration
Program Registration is due BEFORE participant starts program. Thank you for your cooperation.
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Email
*
Your email
Which program are you registering for?
*
The Miss Project (Podcast) Session 1: January 25th -March 31st Ages 11-14
Rich City Reads (Book Club): Saturdays March 5th-May 28th. Ages 5-10
The Miss Project (Podcast) Session II: April 12th-June 2nd Ages 11-14
GETT To Work Program (Paid Internship) March 23rd-June 4th Ages 14-18
Other:
Required
Student Name
*
Your answer
Student Date of Birth
*
MM
/
DD
/
YYYY
Student Race
Your answer
Student Home Address (include city & zip)
*
Your answer
Student Cell
Your answer
Student Email
Your answer
Student School
*
Your answer
Student current grade
*
Your answer
Does student participate in the Free/Reduced Lunch program?
*
Yes
No
Does the student have any known allergies?
*
Yes
No
If student has allergies, explain here:
Your answer
Parent Name
*
Your answer
Parent Email
Your answer
Parent Phone
*
Your answer
2nd Caregiver Name
Your answer
2nd Caregiver Email
Your answer
2nd Caregiver Phone
Your answer
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