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 
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

Website :www.queeniam.org

Monthly :https://square.link/u/EkWb6sjl
Yearly :https://square.link/u/rs3qmNg0
Sign in to Google to save your progress. Learn more
Email *
Parents Phone Number
Enrollment Plan *
Child 's Name *
Current School Attending
Parent's Name *
Email *
Address *
Any Allergies?
Tee Shirt Size
Best Way to Commuicate
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy