Go, Girl, GO Registration
Go, Girl, Go! is a workshop series that combines important topics and fun activities from a curriculum that is therapeutically based to encourage, inspire, and support your daughter and equip her with the tools to assist her through the trials of growing up in today’s society.

To register, complete the form below. Registration is not complete without accompanying payment.
Today's Date *
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Name: *
(adult/s responsible for the child)
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Relationship to child *
Street Address *
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City *
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State *
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Zip Code *
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Phone number *
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Ok to leave a detailed message? *
Email Address *
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Child's Name *
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Child's Age *
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Child's Date of Birth: *
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School *
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Grade *
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Alternate Emergency Contact Name *
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Phone Number: *
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Has your child received counseling in the past? *
If yes, please give additional info on when the services were provided, where (school, private office, inpatient).
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Has your child been prescribed psychotropic medication? *
If yes, please list
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What do you hope for her to gain from joining the group? *
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How did you hear about "Go, girl, GO!" *
Additional Info or Questions
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