GPU Membership Application

Membership Application

To apply for membership please complete all required questions.
Please complete this section for the youth applying. Each applicant will need to complete separate applications if you have more than one youth applying.
Applicant Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Applicant Email*
example@example.com
Applicant Phone Number*

Area CodePhone Number
Grade Level*
List current grade level.
Applicant T-Shirt Size*
Applicant T-Shirt is included in membership
Who referred you?
Applicant Signature*

Clear
Signature required for form to be valid.
Applicant's Date Stamp

MonthDayYear
Date
This section to be completed by the parent(s)/guardian(s) responsible for the youth applying. Membership for youth requires a parent/guardian signature on file upon registration to be valid.
1st Parent/Guardian Name*

PrefixFirst NameLast Name
2nd Parent/Guardian Name

PrefixFirst NameLast Name
Best Contact Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
1st Parent Email*
example@example.com
2nd Parent Email
example@example.com
What would you like to get most out of joining this group?

Career TrainingNetworkingFinancial LiteracyLearning a new skillPersonal DevelopmentEntrepreneurship TrainingSelf-EsteemOther
Parents/Guardians: Volunteers are needed for this program to be successful. Field trips, fundraisers are necessary to help the youth group financially. We require at least participation in one field trip throughout the year as a chaperone.

We appreciate our parent support!
How would you like to volunteer?*

For anything!Chaperone OnlyOther
By selecting this field you have agreed to complete the Adult Waiver of Liability and submit it upon completion. All adults should complete this form for volunteering and chaperoning purposes for participation and activities for Girl PowerUP Youth Group.*
1st Parent/Guardian Signature*

Clear
1st Parent/Guardian Date Stamp

MonthDayYear
Date
How would you like to volunteer?

For anything!Chaperon OnlyOther
By selecting this field you have agreed to complete the Adult Waiver of Liability and submit it upon completion. All adults should complete this form for volunteering and chaperoning purposes for participation and activities for Girl PowerUP Youth Group.
2nd Parent/Guardian Signature

Clear
2nd Parent/Guardian Date Stamp

MonthDayYear
Date
1 Year Annual Membership for Applicant*

prevnext( X )
USDFees due every March 1st. (Fees waived during until June1, 2020.)
We would like to welcome you to our community and thank you for supporting Girl PowerUp!

You can find more information about us here!

website: Girl PowerUp Website

Facebook: https://www.facebook.com/groups/girlpowerupyouth/

Email us @ Girl PowerUP for more info.
To make payment via PayPal click HERE. You will be redirected to PayPal for payment of the $10 membership fee only. Once complete, please specify you've paid via PayPal in the next field. This will help us post the appropriate payment to the applicant.

If you are requesting parent shirts, we will invoice you for the total due separately.

Thank you!
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