Girls Hub Pre-Application
Girls Hub is a STEAM summer program/activity for girls and young women ages 12 to 18 that offers a dedicated workspace in design and construction, through classes in carpentry, architecture, and art.
https://www.womenoftoledo.org/girlshub

Please complete this form is you are interested in participating as a Builder or parent/guardian of a minor Builder (<18 year of age) for our Young Women -Girls Hub summer program. By completing this form you acknowledge that you’re giving up certain legal rights and hereby represent and warrant to Women of Toledo:
(1) You are over the age of majority in your jurisdiction of residence.
(2) You are registering on behalf of a minor and are his/her parent/legal guardian and as such are fully authorized and entitled to enter into this agreement on his/her behalf.

IN ORDER FOR REGISTRATION FORMS TO BE PROCESSED, ALL SECTIONS MUST BE COMPLETED.
**Once your application is accepted, you or your parent/legal guardian must sign program agreement in person at our office 425 Jefferson Ave 3rd Floor Toledo OH 43604. Program agreement includes:
1. Photo/video consent, assignment and release form
2. Assumption of risk and indemnifying release
3. Health History & Medical Emergencies
4. Emergency Contacts & Pickup
5. Code of Conduct and Understanding of DEI policy.

**Note we ask for demographic for our GRANT reporting, not as a determining factor for participating. No personal information will be listed in grant reporting or publicly. All information provided is only for internal purposes and is confidential. Thank you!  
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Section A: Main Contact
If you are 12 to 18 years old, please consult your parent/legal guardian to support you this section.
Parent/Legal guardian : By submitting your info on Section A, you are registering on behalf of a minor and are his/her parent/legal guardian and as such are fully authorized and entitled to enter into this agreement on his/her behalf.

First Name (Parent/Legal Guardian):
Last Name (Parent/Legal Guardian):
Full Mailing Address (with zipcode) *
Email Address:
Phone number:
Section B: Builder Information
Builder must be between12 to 18 years of age.
First Name: *
Last Name: *
Builder's Birthday: *
MM
/
DD
/
YYYY
Full Mailing Address (with zipcode) *
School/College/Occupation: *
I Identify my ethnicity as: (select all that apply) *
Required
Which session are you interested in participating?
**Team 1 session - June 3 to June 7 only enrollment for Builders Class 2022 & 2023
 *
Required
Girls Hub T-Shirt for Builder *
Section C: Payment Information & Financial Assistance
One-week Summer Day Camp fee: $175 (Mon- Fri, 9am to 4pm includes program material, T-shirt, swag bag, and mid- morning snack, lunch and afternoon snack)
Total: $200 **

**We are providing a scholarship for ALL Builders on weekly basis through our partnership with the City of Toledo, Department of Parks & Youth Services. We strive to provide all underserved/minority/marginalized youth with a one‐week day camp experience. Priority is given to Girls and young women ages 12 to 18 in this target zip code area 43604, 43605, 43606, 43607, 43608, 43610, 43611, 43620 **not limited to zip code as our program is open to all to promote diversity, inclusion and belonging.
I am interested in applying for Financial Assistance. * If you answer YES, we will contact you with a Financial Assistance Application. Please know all information is kept confidential.
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Thank you for the application!
We will contact you by May 10th for the next steps if Builder's application is accepted. If you have further inquiry please contact our Program Associate, Julia LaBay at Julia@womenoftoledo.org 
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