Enrollment Form
This form serves a purpose to express interest and enrollment into Queen IAM NEW Girl Empowerment Program.
Membership Monthy Fee:$50.00
Daily Drop In : $5.00
Call for Yearly Fee

One on One Mentoring
Once a Month Meets Up 
 Workshops
Resource Library
 Positive Affirmations + Support
Parental Support
Queen IAM Gear 
Access to Events/Programs 
Behavioral /Academic Support

If you have any question please contact Dameyonna Willis

www.queeniamgirlempower@gmail.com
Website :www.queeniam.org



Monthly :https://square.link/u/EkWb6sjl
Daily:https://square.link/u/lbqUa35E
Yearly :https://square.link/u/rs3qmNg0
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Email *
Parents Phone Number
Enrollment Plan *
Required
Child 's Name *
Grade/Age
Current School Attending
Parent's Name *
Email *
Address *
Any Allergies?
Tee Shirt Size
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