ELEVATEHER NETWORK, INC. Participant Registration Form (Ages 6

PARTICIPANT INFORMATION
ELEVATEHER NETWORK, INC. Participant Registration Form (Ages 6–18)

Mentorship • Leadership • Education • Empowerment. Thank you for your interest in ElevateHER Network, Inc. Our mission is to empower girls ages 6–18 to rise with confidence, clarity, and power through mentorship, leadership development, educational experiences, and empowerment opportunities.
Participant Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Age
Grade (2026–2027 School Year)
School
T-Shirt Size
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name

First NameLast Name
Relationship to Participant
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State
ZIP
Preferred Method of Contact
ABOUT YOUR DAUGHTER
What are your daughter’s strengths or talents?
What goals do you have for your daughter through ElevateHER?

Other
If Other, please specify your goal
What activities, hobbies, or interests does your daughter enjoy?
Please share any additional details that would help us support your daughter in the program.
MENTORSHIP PROGRAM INTEREST
Would you like your daughter to participate in the ElevateHER Mentorship Program?
Are there any preferences or information you would like us to consider when matching your daughter with a mentor?
Is there anything you would like a mentor to help your daughter with?

Other
If other, please specify
Mentorship Program Interest
HEALTH & SAFETY INFORMATION
Does your daughter have any allergies, medical conditions, dietary restrictions, or accommodations we should be aware of?
Emergency Contact Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
PARENT/GUARDIAN AGREEMENT
I have read and agree to support my daughter’s participation in ElevateHER Network, Inc. youth development programming, including mentorship, leadership, education, empowerment activities, and program expectations and guidelines.
Parent/Guardian Signature
Date

MonthDayYear
Date
Should be Empty:

PARTICIPANT INFORMATION

ELEVATEHER NETWORK, INC. Participant Registration Form (Ages 6–18)

PARENT/GUARDIAN INFORMATION

ABOUT YOUR DAUGHTER

MENTORSHIP PROGRAM INTEREST

HEALTH & SAFETY INFORMATION

PARENT/GUARDIAN AGREEMENT