Girls Club Spring 2026 - Interest/Enrollment
The group runs on: Tuesdays from 7:30-9pm for 6 consecutive weeks
Start Date: March 10th, 2026
Location: 440 W. Main St. Patchogue
Out of pocket cost  $75/Session

Once enrolled you will be committing to all 6 weeks & payment will be due in full by 3/1/2026
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Email *
Best contact phone number: *
Child's First Name: *
Child's Last Name:
Name of person filling out this form: *
Relationship to child: *
Child's DOB *
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DD
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YYYY
Child's grade:
What school does your child attend?
Does your child receive any in-school accommodations through an IEP or 504 plan?
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Although you will be charged for all sessions, in order for us to best prepare supplies, are there any dates that you know your child will not be able to attend? 
What are your primary concerns for your child? (check all that apply)
What are you hoping your child will get out of this group?
In the future if we offered parent training what topics would you be interested in learning about?
Thank you for completing the interest / enrollment form for Girls Club for the Spring of 2026- Make sure to click the submit button below.
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