GITSL June 21-25 Upper Elementary Program
Incoming 3rd, 4th and 5th grade girls only! Completing this form reserves a spot for the half day, one week program.
Child's First Name *
Child's Last Name *
Child's Grade *
Girl's email address to use for a Soundtrap account. This is an optional tool for girls to create electronic recordings on their own time. Accounts are good for the entire summer.
Primary Contact (Parent/Guardian) Full Name: *
Primary Contact (Parent/Guardian) Phone Number: *
Primary Contact (Parent/Guardian) Email: *
Allergies & Medical Conditions
Comments or information for the Director & Coaches?
Alternate Contact Name & Number. Please list anyone who you authorize to pick up your child in addition to the adult guardians listed above. All adults authorized for pick-up MUST present a photo ID at the time of pick-up. Also, if your child has permission to walk, bike, skate home with another parent, nanny, friend or older sibling please indicate as such.
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: *
How did you find out about this program? *
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