2024 Girls on Adventure Application
Participant
*
First Name
Last Name
Birthdate
*
Current School and Grade
*
Why are you interested in our Girls on Adventure program? What do you hope to learn?
*
Parent / Guardian
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Why do you want your child to participate in this program?
*
Where did you learn about the program?
*
The program runs from 8am - 1pm. The group meets each morning on Harbor Loop, on the hill opposite Maritime Gloucester. A staff person will be there each morning by 7:45am to welcome the girls. How will your child be getting to and from Harbor Loop each day of the program?
*
Drop off/Pick up
Walking
Other
If pick up is not by parent, give authorized pick up person's name
*
Authorized pick up person's phone
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Does your child speak English?
*
Yes, very well
Yes, with assistance
Not much
Not at all
What languages are spoken at home?
English
Español
Portugues
Other
Does your child have any allergies or medical issues we should be aware of? Do they have any special learning needs?
*
We ask students to bring lunch each day. We provide snacks and drinking water. If providing lunch will be difficult for you, please let us know, and we will make arrangements:
Confirmation of Intent
Girls on Adventure is funded by the Applied Materials Foundation and other generous donors. This funding allows us to make the program 100% free of charge to all participants. In exchange, we expect that participants only register if (a) they truly want to attend the program; (b) they are able to attend at least nine (9) of the twelve sessions; (c) they agree to fully participate in this unique with enthusiasm and sincerity. Submission of this form is considered agreement to the statements in this paragraph.
Submit
Should be Empty: