2022-2023 PBG Academy Registration Form

PBG Academy Registration Form - Dixon Educational Learning Academy

Pretty Brown Girl is dedicated to empowering Black and Brown girls. You are receiving this form because your student has an opportunity to participate in Pretty Brown Girl Academy at Dixon. Sessions will take place on Tuesdays for 4th and 5th grade, and Thursdays for 6th-8th grade. All sessions will be held from 3pm-5pm EST. If you have any questions completing the form, please contact LaTonya Reese at lwalton@prettybrowngirl.com.
Student Name*

First NameLast Name
Student Grade Level*
Student Email (if applicable)
T-Shirt Size*
Please note that one complimentary T-Shirt will be provided for the student. All PBG T-Shirts come in unisex sizes with a looser fit. Please review the sizing chart below to ensure the correct size is selected before submitting this form. Exchanges will not be permitted.
Parent/ Guardian Name*
Parent/ Guardian Email*
Parent/ Guardian Phone*
Relationship To Student*
If other, please share
YesNo
YesNo
Do you agree to our Terms and Conditions?*
Should be Empty:

PBG Academy Registration Form - Dixon Educational Learning Academy