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Embracing Abilities - EmpowerHer Group Sign Up Form
Please complete and submit this form to register. If you have any questions, contact us at programming@embracingabilities.com.The group will begin meeting on January 8, 2026. Once registrations are reviewed, we’ll send an email with additional details as the start date approaches.We’re so excited to kick off this new group and can’t wait to see you there!
Consumer's Name
*
First Name
Last Name
Consumer Email
example@example.com
Consumer Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please review the Safety and Success Guidelines listed above and confirm that the consumer meets the outlined criteria and is appropriate for participation.
*
Yes, the consumer meets the Safety and Success Guidelines listed above.
No, the consumer does not meet the Safety and Success Guidelines listed above.
I understand that this group meets monthly on the first Thursday of each month. I agree to bring $20 in club dues to each meeting, along with any additional spending money needed for that evening’s planned outing.
*
Yes, I agree.
No, I do not agree.
Thank you! We will review these registration forms and contact you with details closer to our first event - January 8, 2026.
Submit
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