CounterHER Founding Team Tryouts Registration 👑🥊
Complete the participant, parent/guardian, medical, and consent details to register for the tryouts.
Try out date
 -
Month
 -
Day
Year
Date
Participant Full Name
*
First Name
Last Name
Participant Date of Birth
*
 -
Month
 -
Day
Year
Date
Participant Gender
*
Please Select
Female
Non-binary
Prefer not to say
Other
Participant's School Name
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Relationship to Participant
*
Please Select
Mother
Father
Legal Guardian
Other
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name (other than parent/guardian)
*
First Name
Last Name
Emergency Contact Relationship to Participant
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does the participant have any allergies or medical conditions?
*
No
Yes (please describe below)
If yes, please describe allergies or medical conditions
Does the participant require any special accommodations?
No
Yes (please describe below)
If yes, please describe required accommodations
What interests the participant about the CounterHER program?
How did you hear about CounterHER?
Please Select
Friend or Family
School
Social Media
Flyer or Poster
Other
Would you like to receive updates about future CounterHER events and programs?
Yes, please keep me updated
No, thank you
Parent/Guardian Electronic Signature
*
Submit Registration
Submit Registration
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