Urban Girl Institute Registration Form 2025

Registration S25

Urban Girl Institute is a summer day camp for girls between 11-14 years old. This summer camp is an extension of The Sophia Project Inc., a nonprofit organization that provides comprehensive mentoring services to support young girls. Our programs focus on helping young ladies reach their full potential in their foundational years by building resiliency, strengthening self-esteem, and overall school performance, developing coping strategies, boundaries, and healthy relationships on every level: peer-to-peer, youth to caring adult, and with authority figures.

Urban Girl Institute is designed to engage young ladies with activities such as STEM, Cultural Development (Camping, Art & Dance), Mindfulness (Yoga & Therapy), and Learning Recovery (Reading and Writing Enrichment) to develop the "whole" person. The Sophia Project youth are encouraged to participate openly in group discussions by asking questions and articulating their perspectives on the various workshop subjects. Youth are provided a safe space to discuss sensitive topics, which could touch on the following issues: domestic abuse, sex, substance abuse, and other traumas. However, The Sophia Project Staff has been trained to manage these conversations with care and discretion, according to the appropriateness of the youth's age.

Summer Camp Dates: June 3, 2025 - June 26, 2025

Locations: 711 N Grand Blvd, 63103

Summer Camp Hours: 8:00 a.m. - 4:00 p.m.

Disclaimer: All Sophia Project Inc. Summer Day Camps are exempt from State of Missouri childcare licensure and are not regulated by the Office of Childhood.
Your Email
example@example.com
Camper's Information
Name *

First NameLast Name
Pronouns
Date of Birth:*

MonthDayYear
Date
Race/Ethnicity: *
Primary Language(s) Spoken at Home:
(e.g., English, Spanish, Mandarin, etc.)
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Camper's Living Arrangements*
School:*
Please note if homeschooled
Grade for 2024-2025 School Year*
Upload Camper's last report card

if you do not have it off hand please email to info@thesophiaproject.org
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Does your child have any unique or special interests helpful for us to know?
Examples: KPOP, drawing, theater, fashion design, robotics, fencing, poetry, and music
Will your child need Before/After Care?

Before Care (7-8am)After Care (4-5pm)
Camper's Medical
Are there any allergies or special dietary needs that should be brought to our attention? *
if not applicable, n/a
Are there any learning disabilities? If yes, please explain.*
if not applicable, n/a
Does the student have any existing medical conditions. If yes, please explain.*
if not applicable, n/a
Are there any mental health diagnoses?*

YesNo
If yes, please explain.
Does your child have medical insurance?*

YesNo
Health Insurance Company*
Please attach copy of health insurance card

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Group No*
if not applicable, n/a
Account No/ Participant ID*
if not applicable, n/a
Family Doctor
Doctor's Name and Phone Number
What is your hospital of choice ? Disclaimer: if none, the Sophia Project will take your child to the nearest hospital.*

Children's HospitalCardinal Glennon HospitalMissouri Baptist HospitalDePaul HospitalSt. Mary's Hospital
Parent /Guardian Information
Parent/Guardian 1 *

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*
Address, City, State, Zip
Parent/Guardian 2

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Address, City, State, Zip
Family Background Information

To help us secure funding and provide the best possible experience for all campers, we kindly ask you to share any optional information about your family's background. This information helps us meet grant reporting requirements and tailor our programs to better serve our community.The information you provide is confidential and will only be used for reporting purposes in a way that protects your privacy.
Total in household under 18yrs
Level of Education

Less than highschoolHighschool/ GEDSome College2 year degree4 year degreeTypPost graduate
Source of Income

Full Time EmploymentPart Time EmploymentSelf-EmployeedUnemployed
Please specify your household income below:

$0-$9,999$10,000-$14,999$15,000-$19,999$20,000-$24,999$30,000-$49,999$50,000-$99,999$100,000 and greater
Are/ Were you a member of the military?
Do you currently receive or within the last 3 years have you received SNAP, TANF, or Medicaid?

YesNo
If your family needs any additional resources support please describe below.
Emergency Contact
Name*

First NameLast Name
Relationship to Camper*
Telephone Number*
Authorized Pick Up Person

The below persons are authorized to pick up camper.
Name*

First NameLast Name
Relationship to Camper*
Name

First NameLast Name
Relationship to Camper
Name

First NameLast Name
Relationship to Camper
Field Trips

Campers will get to participate in weekly field trips exploring the St. Louis area.
The Sophia Project has my permission to transport my youth to and from weekly offsite outings for the Urban Girl Institute.

1. It is my/our understanding that the group will be transported to and from weekly offsite outings by bus. I also understand that every reasonable effort will be made to plan for safety on this trip. Nevertheless, I agree to assume full responsibility for any personal injury or any damage to my student’s personal property that may occur directly or indirectly during these outings.

2. I/we acknowledge that every effort will be made to contact the designated parent/guardian in the case of a medical emergency. If I/we cannot be reached, I/we authorize The Sophia Project/ Urban Girl Institute Staff, to seek appropriate medical(physician, dentist, nurse, etc.) care for my student.
Parent/Guardian Name*

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Today's Date*

MonthDayYear
Date
Photography and Videography
A photographer and video crew will be on-site to document some sessions, workshop presentations, and activities. Any photos and videos taken will be used in newsletters, brochures, and reports to promote The Sophia Project Inc.'s valuable work.

The Sophia Project has my permission to take pictures of my youth and to use those photos for promotional purposes, e.g., brochures, flyers, other print material, and social media.
Signature of Parent/Guardian*

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I acknowledge that the Sophia Project is exempt from licensure in the state of Missouri Please sign below*

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By signing below, I confirm that the information provided in this application is accurate to the best of my knowledge. I understand that this information will be used to support my child’s participation in the summer camp program and for reporting purposes as needed.*

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Today's Date*

MonthDayYear
Date
Thank you for taking the time to complete this application and for entrusting us with your child’s summer camp experience. Your responses help us ensure a safe, fun, and enriching environment for all campers. If you have any questions or additional information to share, please don’t hesitate to reach out.
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Registration Deposit
$150.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Camper's Information

Camper's Medical

Parent /Guardian Information

Family Background Information

Emergency Contact

Authorized Pick Up Person

Field Trips

Photography and Videography