HER Saturday's Registration Form

HER Saturday Registration Form

We believe that every girl deserves the opportunity to shine brightly and reach her full potential. Our program is a transformative journey designed to inspire, educate, and empower young girls to become confident, resilient, and successful individuals.Through personalized empowerment, interactive workshops, and engaging activities, we provide a safe and supportive space for girls to explore their passions, set ambitious goals, and develop crucial life skills.
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Grade Level
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.
Transportation (please check the form of transportation after the session)
Please select the Saturdays you would like your daughter to attend, or choose “All Sessions” to register her for the full HER Saturdays experience. It’s perfectly fine if she cannot attend every date—there is no penalty. Choosing “All Sessions” simply saves you from having to register each month.

Note: We understand life gets busy! Signing up for all sessions keeps things simple and ensures your daughter always has a spot, even if she can’t make it to every Saturday.

Location and Time (Every session):

IamHER Suite

2716 E. Lancaster Ave #103

Fort Worth, TX 76103

Time:

11:30am-1:00pm
Saturday Options
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 you student have any physical limitations
If "YES" explain
Is your student currently on any type of medication needed to be taken during programing ours?
If "YES" explain
Name any Allergies:
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
If you have any questions or concerns, please don’t hesitate to reach out. You can contact us by phone at (817)451-6565 (ext 108) or by email or Director at ashley.spriggs@teamiamher.org , and a member of our team will be happy to assist you.

We value your support and look forward to connecting with you!

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HER Saturday Registration Form

Demographics:

Release Waver

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