Firefly Program Registration Form

Firefly Program Registration Form

A holistic electrician and leadership training program for young women to explore the fundamentals of Electrical Technology, build meaningful relationships, and help their communities. Participants will engage in technical training, hands-on group projects, and mentorship in a fun and interactive space.
Program workshops are monthly. First workshop is October 14, 10AM - 12PM.

Topics will include:
- Fundamentals of Electricity
- Working Safely with Systems
- Wiring Methods
- Lighting Types
- Materials and Equipment
- Residential Lighting Bascis
- Commercial Wiring Basics
- Emergency Power Equipement
- Intro to Smart Home Systems
Deadline to register is October 13!

Participation fee is $50. This helps to cover the cost of the Student Kit that we will provide.

The Student Kit is valued at $315, and includes necessary safety equipment, and overalls.

Scholarships are available, and nobody will be turned away due to a lack of funds.
Please describe your knowledge on electricity

I don't have any idea at allI'm a newbieI have watched tutorials onlineI have some knowledge and experience and want to improve my skillsOther
Participant Information
Name

First NameLast Name
Preferred Name and Pronouns
Example: She/her; They/them
Date of Birth

MonthDayYear
Date
School
Grade
Phone Number
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you interested and in need of a scholarship for the participation fee?

YesNo
Any additional comments or information you would like to share?

Parent or Legal Guardian Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

St. Stephen’s Episcopal Church
Media Release Form 2023-2024

Released Parties include St Stephen’s Episcopal Church, the rector, and any officer, employee, agent, contractor, and representative of the foregoing.

Releasing Parties include the participant and anyone else who might claim or sue on the participant’s behalf.

I give St Stephen’s Episcopal Church permission to photograph, film, or record my activities with the Firefly Program and use any relevant photos, video clips, audio clips, and all other media including and involving me for any legitimate purpose, including, but not limited to: their own advertisement, marketing, fundraising and the general promotion of St Stephen’s and/or the Firefly Program in print, video, on the radio, on the Internet (to include all Social Media), and in any other form of visual and audio media. I grant St Stephen’s Episcopal Church the rights to aforementioned material and permission to share and publish in perpetuity.

Additionally, I give permission to St Stephen’s Episcopal Church to publish online, in newsletters, and in other written materials, stories and information about my experience that I create throughout the Firefly Program.
Participant's Signature (Or Parent/Legal Guardian's Signature if under 18 years old)

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Firefly Program Registration Form

Participant Information

Parent or Legal Guardian Information