GIRLS ONLY ages 5-12
Event Timing: June 10, 2019 - August 16, 2019 7am - 6pm every M-F
Cost: $100/week/per girl OR $750 in full for all 10 weeks - $35 Registration Fee
All Payments are NON-REFUNDABLE
Event Address: Girls Inc. 260 Broadway, Richmond, CA. 94804
Contact us at (510) 232-5440 or
Child's First Name__________________________Last_____________________
Date of Birth:___/___/___ Grade:______ School:_______
City:____________ State:_______ Zip Code:________
Child's Cell Phone:_____________________
Child Lives With:__Father__Mother__Step Parents__ Foster__Legal Guardian __ Other ( if so, please explain)________________# of People in Home:_______
Primary Language Spoken At Home:
Never submit passwords through Google Forms.
This form was created inside of Girls Inc of West Contra Costa.
Terms of Service