Girl Talk/Book Club Form

Girl Talk/Book Club Form

Organized by: Best Version of You Life Coach and Mentoring LLC Facilitator: Coach Nifeesa Haqq
Participant Information
Name of Child

First NameLast Name
Age:
Grade:
School:
Date of Birth
Month
Day
Year
Parent/Guardian Name(s)

First NameLast Name
Phone Number:
Email Address:
Emergency Contact Number/Name
Relationship to child
Health & Safety
Allergies or Medical Conditions
Medications(if applicable):
Does your child require any accommodations?
Parent Signature

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Be sure to check the club(s) your child will be attending?

Girl Talk ClubBook ClubBoth
Should be Empty:

Participant Information