Summer Camp Detailed Registration Form

Girl Goals Summer 2026 Program Registration
Girl Information

First NameLast Name
Birth Date

MonthDayYear
School ✓
Grade entering in September 2026
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
This is a fill in the blanks field. Please add appropriate blank fields and text.
T-Shirt Size
Parent/Guardian Information
Parent 1

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
Parent 2

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Name & phone number of person(s) other than parents your child can be released to for pick up.

Any special intructions such as custody or retraining orders must be emailed to GirlGoals@sayeghcivic.org and discussed personally with the director. All information will be kept confidential.
Name

First NameLast Name
Phone Number.
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contacts

Every effort will be made to contact the Parents/Guardians first:
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Medical Information
Health Care Provider
Physician

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Insurance Information

Insurance CompanyPolicy Number
Does your child have any allergies, food allergies or restrictions, chronic illness, or medical conditions? If yes, please describe.
Does your child have prescribed an inhaler, EpiPen or any prescribed medications? If yes, please explain any instructions.
Use the space below to provide any additional information about the child's behavior and physical, emotional, or mental health which would assist in providing your child the best program experience.
Medical Release and Authorization

As Parent and/or Guardian of the named, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Girl Goal Summer Program and its affiliates including Staff and Volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Informed Consent and Acknowledgement

I hereby give my approval for my daughter's participation in any and all program activities prepared by Girl Goals Summer Program including all weekly field trips and swimming at Lou Costello Pool. In exchange for the acceptance of said child's enrollment, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Girl Goals Summer Program and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected program sessions.

In case of injury to said child, I hereby waive all claims against the Girl Goals Summer Program including all staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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Program Enrollment Fee includes one T-shirt

One-time Program Registration Fee due with initial enrollment into program. Payment for weekly sessions are due 1 week prior to the start of the weekly session.

$100.00

Grow Girl, Grow! Monday, July 6 - Friday, July 10, 2026

This week focuses on personal growth, wellness, and connection to nature. Girls explore gardening, mindfulness, and self-care while learning how patience, responsibility, and consistency help them thrive. Through hands-on planting activities and reflective journaling, participants connect nurturing plants to nurturing themselves. The week sets a positive, calming foundation for the summer. Field Trip: Laurelwood Arboretum

$115.00

Global Chefs Monday, July 13 - Friday, July 17, 2026

Girls step into the kitchen to build confidence through cooking, nutrition, and life skills. Participants practice measuring, following recipes, and kitchen safety while preparing simple and culturally diverse foods. This week blends math, reading, teamwork, and creativity in a fun, hands-on way. Girls also explore healthy choices and independence through food preparation. In house visit and demonstration from a Professional Chef.

$115.00

Stage Ready Monday, July 20 - Friday, July 24, 2026

Stage Ready encourages girls to build confidence and self-expression through dance, drama, and music. Participants explore movement, voice, and performance while learning teamwork and public-speaking skills. Through rehearsals and creative games, girls gain courage and self-confidence. The week culminates in a showcase celebrating each girl’s creativity. Field Trip: Madame Tussaud’s NYC

$115.00

STEMinistas & Curious Minds Monday, July 27 - Friday, July 31, 2026

STEMinistas & Curious Minds inspires curiosity and problem-solving through hands-on STEM activities. Girls explore science, technology, engin|eering, and math through experiments, challenges, and innovation projects. Participants learn that creativity and persistence are key parts of discovery. Women in STEM are highlighted to inspire future pathways. Field Trip: Paterson P-Tech Planetarium

$115.00

Boss Girls & Bright Futures Monday, August 3 - Friday, August 7, 2026

Boss Girls & Bright Futures introduces girls to entrepreneurship, financial literacy, and career exploration. Participants learn how businesses are created, how money works, and how leadership skills shape future success. Through mini business projects and role-play, girls practice decision-making and teamwork. This week empowers girls to see themselves as future leaders. Field Trip: Statue of Liberty

$115.00

Camp Olympics: A Summer of Team Spirit Monday, August 10 - Friday, August 14, 2026

This summer, we’re bringing the excitement of the Olympics to our local park with Camp Olympics — a high-energy, inclusive camp experience built around teamwork, fitness, and sportsmanship for all skill levels. Camp Olympics is designed so every girl participates, contributes, and succeeds. Our games are adapted to be inclusive, ensuring beginners feel confident and experienced campers stay challenged. Field Trip: Pennington Park

$115.00

She Did That! Monday, August 17 - Friday, August 21, 2026

She Did That! is a celebration of growth, confidence, and achievement throughout the summer. Girls reflect on what they have learned, set future goals, and recognize their accomplishments. Activities focus on pride, gratitude, and leadership. The week concludes with a graduation-style celebration honoring each girl’s journey. Field Trip: Local Paterson Restaurant

$115.00

Additional Program T-Shirts

$12.00 Quantity

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Girl's Name

First NameLast Name
Girl Goals Summer Program Refund Policy:

Early Cancellation:
Full refunds if within one week of the start of the weekly session.

Later Cancellation:
Refunds unavailable after one week of the start of weekly session.

No Refund:
No refund at the start of the weekly session.

Exceptions:
Refunds for Medical/Emergency Circumstances will be consider on a case-by-case basis for situations that include a medical condition or an emergency. Documentation will be required.

If the program itself cancels a weekly session, a refund will be offered.
Should be Empty:

Girl Goals Summer 2026 Program Registration

Emergency Contacts

Medical Information

Health Care Provider

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