Summer Camp Registration Form

LeadHERship Camp Registration Form

HER Future starts HERE!This year’s IamHER Summer Camp theme is HER Future: Community, College & Career Our girls will explore what’s next through hands-on activities, college and career exposure, guest speakers, field trips, and real-life skill building — all while growing in confidence and discovering their path
Camp Informaiton:

🗓️ Dates: June 1–26 (Monday–Friday)

⏰ Camp Time: 9AM–3PM

🌅 Early Drop-Off: 7:15AM Late Pick-Up: 5:30PM

📍 Location: The Bethlehem Center951 Evans Ave, Fort Worth, TX 76104

Registration Includes: Breakfast, Lunch, Snacks, Camp Shirt, and Field Trips

*You can register siblings on the same form—just add them to this application and enter code HER in the discount field for the sibling discount. 💗

For Question:

Phone: (817) 451-6565 ext 108

Email: info@teamiamher.org
Participant Name

First NameMiddle NameLast Name
(Sibling) Participant Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
(Sibling) Birth Date

MonthDayYear
Grade Level
(Sibling) Grade Level
Shirt Size (Shirts are unisex adult sizes)
(Sibling) Shirt Size (Shirts are adult sizes)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent

First NameLast Name
Parent E-mail
example@example.com
Parent Mobile Number
Format: (000) 000-0000.
Emergency #1

First NameLast Name
Emergency Number
Format: (000) 000-0000.
Emergency #2

First NameLast Name
Emergency Number
Format: (000) 000-0000.
IamHER has permission to contact me via text message using IamHER text communication system:
Demographics:

The following set of questions are demographic in nature. The answers to the following questions enable IamHER to continue providing community-based services that educate and empower girls.
Participant Ethnicity:
Household
Household Income
Does your daughter have any physical limitations
(Sibling) Does you daughter have any physical limitations
If "YES" explain
Is your daughter currently on any type of medication needed to be taken during programing ours?
(Sibling) Is your daughter currently on any type of medication needed to be taken during programing ours?
If "YES" explain
Name any Allergies:
Would you be like UCC to provide a literacy assessment with a Literacy Specialist for your child? This assessment will help you understand your child's current reading level and provide valuable insights to support their learning journey.
Release Waver

Liability release with IamHER as described below.
Please check all boxes for release

ACTIVITY LIABILITY RELEASE:It is understood and agreed that the undersigned shall not bring or cause to be brought an action due to accident,illness including COVID-19,death or personal injury to his/her self, his/her child or property damage that might result from his/her child’s participation in any IamHER sponsored activity,on or off campus, whether under the direct supervision of IamHER, its staff,employees,agents,affiliates,contractors, parents, or teachers.PROMOTIONAL RELEASE:I hereby consent to the use of any videotapes,photographs,slides,audiotapes, or any other visual or audio reproduction IamHER in which may appear. I understand that these materials are being used for promotion of IamHER, which includes recruitment and fund-raising efforts. I release IamHER from any liability connected with the use of a picture of voice recording as part of any promotional,recruitment,or fund-raising program.
Signature
Date

MonthDayYear
Date

Please check the box below to confirm your payment and secure your child’s spot in the program.

LeadHERship Camp

Join us for an exciting 4-week summer experience designed to build confidence, leadership skills, and financial smarts for girls ages 11-14! Through hands-on activities, inspiring guest speakers, and fun field trips, all while having an unforgettable summer!

$220.00 Quantity

Enter coupon

Total

Payment Methods

Credit Card

Apple Pay

Google Pay

If financial support is needed, please email ashley.spriggs@teamiamher.org
for assistance.
Should be Empty:

LeadHERship Camp Registration Form

Demographics:

Release Waver

Please check the box below to confirm your payment and secure your child’s spot in the program.*

Payment Methods

Please check the box below to confirm your payment and secure your child’s spot in the program.