Girls Inc. of Delaware Membership Form

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This form is used for Membership Registration and Program Registration.

This form will adjust for your needs!

If you are, or if you have a girl who would like to participate in Girls Inc of Delaware programming, memberhip is required.

What is the Girls Inc. Membership Experience?
Joining Girls Inc. of Delaware means being supported, inspired, and empowered. Members gain access to enriching events, meaningful mentorship, and a safe, encouraging environment to learn, lead, and thrive.

Who Can Join?
Kindergarten through post-secondary students (ages 5-24).

Why Join?
• Build leadership skills
• Discover strengths and new skills
• Be yourself without judgment
• Access scholarships and trips
• Form lifelong friendships and sisterhood

Membership is FREE—join today!
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Are you or is your girl already a Girls Inc of Delaware Member?* This field is required.
Yes
No
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Do You Want to Enroll in a Girls Inc. Program?
Yes
No
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Out-of-School Time Programs
At Girls Inc. of Delaware, we inspire girls to be Strong, Smart, and Bold™ through free, high-quality programs that support academic growth, leadership, and social-emotional development.

Enrollment Update
Enrollment for our Saturday Out-of-School Time programs is currently closed until the beginning of the next school year. Details about upcoming seasonal programs will be shared soon.
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Pick Program For EnrollmentPick multiple if enrolling more than 1 girl
Bold Beginnings (K-3rd)
Bright Futures (4th-5th)
She Leads (6th-8th)
Project Dream Bold (9th-10th)
Project Accelerate (11th-12th)
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Parent/Guardian Full Name* This field is required.
First Name
Last Name
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Parent/Guardian Cell* This field is required.
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Parent/Guardian Email Address* This field is required.
example@example.com
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Household Type / Family Configuration* This field is required.
Two-parent Household
Mother-only Household
Father-only Household
Guardian-led Household
Other
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Household Income Category* This field is required.
Under $10,000
$10,000 - $14,999
$15,000 - $19,999
$20,000 - $24,999
$25,000 - $29,999
$30,000 - $34,999
$35,000 - $40,000
$40,000 - $45,000
$45,000 - $50,000
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Zip Code
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Participant's Full Name* This field is required.
First Name
Last Name
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Participant's DOB* This field is required.
mm/dd/yyyy
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Participant's Grade* This field is required.
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Age of Girl #1
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Participant's School Attending* This field is required.
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Participant's Primary Language* This field is required.
English
Spanish
German
French
Arabic
Chinese
Other
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Participant's Race/Ethnicity* This field is required.
White
Hispanic or Latina
Asian American
Black, African, or African American
Asian, South Asian, Southeast Asian, or Central Asian
Native American, Indigenous, Alaska Native
Middle Eastern or North African
Native Hawaiian or Pacific Islander
Multiracial or more than one race
Other
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Participant's Allergies * This field is required.N/A if not applicable
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Additional Information* This field is required.Please provide any additional information that will help us best support your girl.
Emotional
Learning
Visual
Hearing
Mobility
Developmental
ADD
ADHD
IEP
Physical
N/A
Other
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Participant's challenges, needs, or accommodations* This field is required.N/A if not applicable
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Would you like to enroll another participant?
YESNO
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Participant #2 Full Name* This field is required.
First Name
Last Name
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Participant #2 DOB* This field is required.
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Participant #2 Grade* This field is required.
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Participant #2 School Attending * This field is required.
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Participant #2 Primary Language* This field is required.
English
Spanish
German
French
Arabic
Other
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Participant #2 Race/Ethnicity* This field is required.
White
Cacausian
Hispanic or Latina
Asian American
Black, African, or African American
Asian, South Asian, Southeast Asian, or Central Asian
Native American, Indigenous, Alaska Native
Middle Eastern or North African
Native Hawaiian or Pacific Islander
Multiracial or more than one race
Other
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Participant #2 Allergies* This field is required.N/A if not applicable
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Additional InformationPlease provide any additional information that will help us best support your girl.
Emotional
Learning
Visual
Hearing
Mobility
Developmental
ADD
ADHD
IEP
Physical
N/A
Other
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Participant #2 challenges, needs, or accommodations* This field is required.N/A if not applicable
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Girl Name #3 N/A if not applicable
First Name
Last Name
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Date of Birth of Girl #3N/A if not applicable
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Age of Girl #3N/A if not applicable
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School AttendingN/A if not applicable
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Grade currently enrolledN/A if not applicable
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Allergies?N/A if not applicable
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Additional InformationPlease provide any additional information that will help us best support your girl.
Emotional
Learning
Visual
Hearing
Mobility
Developmental
ADD
ADHD
IEP
Physical
N/A
Other
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What additional support if neededN/A if not applicable
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Street Address
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Apt
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City
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State
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Zip
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Mother Full Name
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Employer
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Work Number
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Father/Guardian Name
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Cell
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Employer
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Work Number
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In the event of an accident/emergency or injury occurs to a girl during program session(s), staff will take the necessary action to protect each girl from further harm. If care is not required by the ER it is our policy to contact parent(s). If the parent is not reached, the staff will call the emergency contact person listed below.
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Authorized Emergency Contact & Pick-Up List

In addition to the parent/guardian, the emergency contact listed below is authorized to pick up participant #1 & #2.
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Emergency Contact's Full Name* This field is required.
First Name
Last Name
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Emergency Contact's Full Name
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Emergency Contact's Relationship to Participant(s)* This field is required.
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Emergency Contact's Phone Number* This field is required.
Please enter a valid phone number.
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Emergency Contact #2 Full Name* This field is required.
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Phone Number* This field is required.
Please enter a valid phone number.
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Relationship to Child* This field is required.
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Treatment/Emergency Care

I hereby grant permission to the emergency care physician and/or Girls Inc. of Delaware staff to order an x-ray, routine tests, and treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by Girls Inc. of Delaware supervisor to secure and administer treatment, including hospitalization, for the person/s named above.
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Signature* This field is required.
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Initial Here* This field is required.
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Administration of First Aid

I give Girls Inc. of Delaware permission to administer basic first aid to my child when needed. I understand that I will be informed in any given situation that my child is ill or injured before picking them up from the program.
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Signature* This field is required.
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Initial Here
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Field Trip/Transportation

Girls Inc. of Delaware has permission to take my child on all pre-arranged field trips.
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Signature* This field is required.
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Is the participant age 15 or older and approved for independent dismissal?
YESNO
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Independent Dismissal

By signing below, I authorize Girls Inc. of Delaware to release my child at the scheduled dismissal time without a parent or legal guardian present, allowing my child to leave independently, including by walking, self-driving, or other pre-approved means of transportation. I accept responsibility for my child upon release and understand that this authorization may be revoked in writing in accordance with applicable policies.
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Signature
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Initial Here
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Media/Movie Release

I give Girls Inc. of Delaware permission for my child to be photographed/videotaped or interviewed for promotional purposes while at the center, during events, field trips, etc.

I also grant permission for my child to view age-appropriate movies as part of the GIDE activities/program.
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Signature* This field is required.
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Initial Here
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Sunscreen Release

I give Girls Inc. of Delaware permission to apply sunscreen provided by me or from the Girls Inc. supplies during programs.
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Initial Here
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Informed Consent

I understand that the Girl Inc. of Delaware activities have inherent risks and I hereby assume all risks and hazards incident to my daughter's (and family's) participation in Girls Inc. of Delaware activities. I further waive, release, absolve, indemnify, and agree to hold harmless Girls Inc. of Delaware, the organizers, volunteers, supervisors, officers, directors, participants, as well as persons or parents transporting participants to and from activities from any claims or injury sustained during participation and/or use of Girls Inc. property.
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Signature* This field is required.
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Initial Here
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Girls are entitled to a pleasant and harmonious environment at the program centers, therefore girls who participate in all programs must abide by the Girls Inc. Agreement.

1. I will be respectful of other people.

2. I will be a good citizen and keep my hands and feet to myself.

3. I will be aware of others' feelings and treat them with courtesy and kindness.

4. I will use appropriate language at all times.

5. I will tell the truth.

6. I will use good manners.

7. I will listen carefully and speak clearly.

8. I will put away my things in their proper place and clean up after myself.

9. I will be respectful of others' property and Girls Inc.'s property.

10. I will remain with my group at Girls Inc. at all times unless I ask permission to leave and I am given permission to do so.

11. I will follow all rules when riding in the van or bus (for field trips).

12. I will keep all electronic devices in my book bag and will not use it while I am at Girls Inc.

13. I will assist in keeping Girls Inc. a bully-free, safe zone.
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Expectation Policy

I affirm that my daughter is in good health and, with appropriate guidance and support, is able to participate in the group experience. We have reviewed and discussed the Girls Inc. of Delaware Expectations Policy together. We understand these expectations are designed to create a safe, respectful, and supportive environment for all participants. We agree to uphold these expectations and acknowledge that, if challenges arise, the Program Director will work to determine appropriate next steps, which may include additional support, temporary suspension, or dismissal if necessary to ensure the well-being of the group.
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Signature* This field is required.
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Philosophy
Our program is committed to creating an environment where every girl and young woman feels safe, respected, and supported. We recognize that behavior and communication are influenced by emotions, experiences, and development. When challenges arise, our focus is to understand what is happening beneath the surface, support emotional regulation, and build skills for healthy expression and relationships.

Staff are trained to respond with empathy, consistency, and respect. We work to strengthen each participant’s sense of belonging, confidence, and leadership while helping them navigate challenges in a positive and empowering way.

Support Process
Step 1: Connection and Safety
When a concern arises, staff focus first on ensuring safety and re-establishing connection. The goal is to help the participant feel calm, supported, and heard.

Step 2: Regulation and Calming
The participant may take a brief pause, step away from an activity, or use a preferred calming strategy. Staff provide guidance and emotional support as needed.

Step 3: Reflection and Understanding
Once the participant is ready, staff talk with them privately to reflect on what happened, identify emotions, and explore possible solutions or next steps.

Step 4: Repair and Accountability
If someone was affected by the behavior, staff help the participant take restorative steps to rebuild trust or repair relationships in an age-appropriate way.

Step 5: Family or Guardian Partnership
If a younger participant (under 18) continues to experience challenges, staff will collaborate with the parent or guardian to create a support plan that promotes consistency between home and the program.

Step 6: Individualized Support Planning
For older youth and young adults, staff will work directly with the participant to develop a personalized support plan focused on emotional well-being, accountability, and skill-building.

Step 7: Team Review and Continued Support
If behavior concerns continue, a meeting will be held with the Program Director, relevant staff, and the participant (and family, if appropriate) to adjust the plan and identify additional supports. Suspension will be considered when prior interventions have been implemented consistently and with fidelity, yet the behavior continues to pose a risk to the safety, well being, or learning environment of the participant or others, and all reasonable supports have been exhausted.

Step 8: Safety and Crisis Response
If someone’s actions create a safety risk, staff will use calm, trauma-informed approaches to de-escalate and protect everyone involved. Families will be informed promptly for minors, and appropriate steps will be taken to review the incident.
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Parent Name
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Parent Signature
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Date
Date
Month
Day
Year
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