Girl Empowerment After School Online Registration

E2F Online 2023/2024 Registration After School Program

To register your child for our Girl Talk after school empowerment program please complete the form below. We'll send confirmation email confirming registration. For more information please visit our website at www.empoweretoflourish.com.
Parent / Guardian Full Name*

First NameLast Name
Parent's E-mail*
Parent/ Guardian email ex. Janedoe@example.com
Cell Phone Number*
(951) xxx-xxxx
Is cell phone the emergency contact?*

YesNo (put emergency contact in coments)
Cell Phone Number*

Area Code (xxx)Phone Number xxx-xxxx
Name of Student*

Student First NameStudent Last Name
Receive updates via*

Text MessageEmailText Message + Email
Grade of participant?*

4th grade5th grade6th grade7th grade8th grade9th grade10th grade11th grade12th grade
Participant Age*
Girls ages 9-14
School Attending*
Current School
Student T-Shirt Size (Losse fit)*
T-shirts are true to size
First time attending an E2F After School Program?*

YesNo
Parent Comments:
list multiple participants in comments
I hereby request and consent that my child or dependent your child's name here be permitted to participate in Empowered to Flourish virtual after school program. I further understand that this program is designed to enhance self concept by guiding at-risk females in self-awareness, self-esteem and self-confidence and that my child will be required to log in virtually and engage in program.

IParent Full Name and First Name Last Name (child's name) pledge to follow all conduct rules and
acknowledge that my failure to obey rules and requirements may result in my removal from the program.
Signature

Clear
Should be Empty:

E2F Online 2023/2024 Registration After School Program