2026-2027 WFGV Leadership Program for Girls

Youth Participant Information
Participant Full Name:

First NameLast Name
Participant Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant Email Address:
example@example.com
Participant Phone Number (If you do not have a cell number, please list the number of your parent/guardian):
Please enter a valid phone number.Format: (000) 000-0000.
Participant Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Participant School/ Program:
List Favorite Hobbies/Activities:
In the event of an emergency, and if a choice is available, which hospital would you prefer your child be transported to?
Transportation Assistance Needed: (Passes will be mailed to the address on file)
Requested Accommodations:
Dietary Preferences/Restrictions:
Please list any additional allergies or medical conditions that we should be aware of to ensure your safety and comfort:
Is there anything we should know about the participant that would help us provide the best possible accommodations?
Parent/Caregiver Information:
# 1: Parent/Caregiver Full Name:

First NameLast Name
Relationship to Participant:
Cell Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Caregiver Email:
example@example.com
# 2: Parent/Caregiver Full Name:

First NameLast Name
Relationship to Participant:
Cell Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Caregiver Email:
example@example.com
If your child is permitted to leave with someone else at the end of each program gathering, please list the full names of all authorized individuals below. Separate each full name with a semicolon (;).
Virtual Program Informational Session
On November 16th, from 6:00pm - 7:00pm, parents, caregivers, and girls will learn about the Youth Leadership Committee, its purpose, program expectations, and the exciting opportunities for leadership development, personal growth, and community engagement.

Attendees will also have the opportunity to ask questions, meet program leaders, and discover how participants can get involved and make a meaningful impact. Attendance is highly recommended, and an RSVP is required.

Please select the link below to RSVP for the informational:
https://us02web.zoom.us/meeting/register/NQtUi_0KTD6e0OVlssMQ2w
Emergency Contact Information
Emergency Contact Name 1:

First NameLast Name
Emergency Contact Phone Number 1:
Please enter a valid phone number.Format: (000) 000-0000.
Email Address 1:
Relationship to Participant:
Emergency Contact Name 2:

First NameLast Name
Emergency Contact Phone Number 2:
Please enter a valid phone number.Format: (000) 000-0000.
Email Address 2:
Relationship to Participant:
Should be Empty:

Youth Participant Information

Parent/Caregiver Information:

Virtual Program Informational Session

Emergency Contact Information