Pathways to Empowerment Membership Application

Pathways to Empowerment Membership Application

2025-2026
Participant Information
Name

First NameLast Name
DOB
Current Age
Current School
Current Grade
T shirt Size
Parent/Guardian Information
Name

First NameLast Name
Relationship
Email
Phone Number
Address
Interest & Aspirations
Why do you want to be a part of this program
Interests/Goals
Focus Areas

CommunicationSelf AwarenessFinancial LiteracyMental Health AwarenessHealth RelationshipsGenerational HealingOther
Emergency Information & Permissions
Health/Allergy

NoneOther
Subscribe to Email List & Monthly Newsletter*

YesNo
Media Release/Consent

YesNo
Thank you for taking the time to complete this application.

Pathways to Empowerment is committed to creating a safe, supportive, and inspiring space for girls to grow in confidence, leadership, and self-worth. Your submission helps us better prepare for meaningful programming that meets each girl's needs.

We look forward to walking this journey with you!
Parental Signature*

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Participant Information