Join The Circle

Girl's First Name

Girl's Last name

Which Cohort Are You Signing Up For?

Ages 8-11

Ages 12-18

Girl's Date of Birth

Month

Day

Year

Girl's Current Grade

Girl's School Name

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Parent/Guardian Phone Number

Emergency Contact Full Name

Emergency Contact Phone Number

Emergency Contact Relationship to Child

Medical & Safety Iinformation

Does your child have any known allergies?

Yes

No

If yes, please list all known allergies.

Does your child have any medical conditions or health concerns we should be aware of?

Yes

No

If yes please explain

Does your child take any medications that we should be aware of?

Yes

No

If yes, please list the medication(s) and any important instructions.

Does your child have any dietary restrictions or food sensitivities?

Yes

No

If yes, please explain.

Emergency Medical Permission

In the event of a emergency, if i cannot be reached, I authorize Girls on Top of the World staff to contact emergency medical services and obtain necessary emergency care for my child.

Yes, I authorize.

No, I do not authorize.

Parent/Guardian Consent & Agreement

I give permission for my child to participate in Girls on Top of the World programs ,activities, workshops, and events.''

I understand that my child is expected to follow the rules, safety guidelines, and behavior expectations of Girls on Top of the World.''

I understand that Girls on Top of the World will take reasonable steps to provide a safe supportive environment for my child.''

Do you give Girls on Top of the World permission to photograph or record your child during program activities and events for organizational, promotional, and educational purposes?''

Yes, I give permission.

No, I do not give permission.

Transportation/Field Trip Permission

Do you give permission for your child to participate in approved field trips and off- site activities organized by Girls on Top of the World?''

Yes, I give permission.

No, I do not give permission.

Date Signed

A safe and empowering space for girls to build confidence, develop leadership skills, practice self love, and grow together.

Emergency Medical Permission

Parent/Guardian Consent & Agreement