GITSL June 15-19 Middle Program
Incoming 6th grade girls only! Completing this form reserves a spot for the one week online program. (If your daughter just completed 5th grade, please determine if you think she would be better suited with this group, or the elementary level group offered on different dates.)
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Child's First Name
Child's Last Name
Girl's email address for online tools. If your daughter has an email address that you'd like for her to use, please list here. Alternatively we will associate any summer online tools to the primary contact's email address unless otherwise noted in the Comments. (i.e. Google classroom for optional activities)
Primary Contact (Parent/Guardian) Full Name:
Primary Contact (Parent/Guardian) Phone Number:
Primary Contact (Parent/Guardian) Email:
LIABILITY WAIVER and MEDIA RELEASE
Liability Waiver: By signing below, you agree to the following:
On behalf of the above-named participant, I assume all risks of participating in this activity or event. I hereby waive, release, and discharge the Girls in the Spotlight Foundation (GITSF) from any and all liability, including but not limited to personal injury, property damage, property theft, or actions of any kind which may hereafter occur to the above-named participant by participating in this program.
In the event of a serious illness or injury, I hereby give permission to the GITSF staff to secure emergency medical care for the above-named participant, and agree to pay for any incurred expenses. I give permission to the GITSF staff to secure transportation (via ambulance) for the participant to the doctor or hospital and I release the GITSF from responsibility in connection with such emergency medical attention.
Type your name to agree to the waiver
Media Release Statement
I give my permission, for myself and/or my child to be photographed/videotaped/audiotaped during participation in the Girls in the Spotlight Foundation programs and for that photograph, audio or video image to be used for the purpose of promoting Girls in the Spotlight programs and events including, but not limited to, publication in brochures, newsletters, website, staff training, podcast content, music videos and grant projects. I understand that such photographs, audios or videos remain the property of the Girls in the Spotlight Foundation.
Media Release: Please choose Yes/No:
Type your name to provide electronic signature:
Comments or information for the Coach?
How did you find out about this program?
Word of mouth
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