Child's Information
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 programs@girlsinc-wcc.org
Email address *
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Child's First Name__________________________Last_____________________
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Date of Birth:___/___/___ Grade:______ School:_______
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Race/Ethnicity:_____________________ Age:________
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Home Address:_____________________________
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City:____________ State:_______ Zip Code:________
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Child's Cell Phone:_____________________
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Child Lives With:__Father__Mother__Step Parents__ Foster__Legal Guardian __ Other ( if so, please explain)________________# of People in Home:_______
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Primary Language Spoken At Home:
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