GITSL Fall Upper Elementary Program
3rd, 4th and 5th grade girls only! Completing this form reserves a spot for the six weeks online series. , or the middle level offered on different dates.)
Email *
STUDENT INFORMATION
Child's First Name *
Child's Last Name *
Child's Grade *
What school are you registered to attend? *
CONTACT INFORMATION
Primary Contact (Parent/Guardian) Full Name: *
Primary Contact (Parent/Guardian) Phone Number: *
Primary Contact (Parent/Guardian) Email: *
LIABILITY WAIVER and MEDIA RELEASE
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: *
Required
Type your name to provide electronic signature: *
Copyright Waiver
Girls will be given the choice to enter artwork inspired by our online series to enter a contest. As the guardian I waive all claims of the copyright of my daughter. This allows COLORpockit to include her design, print it and sell it should it be chosen for the girl created Girls in the Spotlight Heroes card deck.
Type your name to agree to the waiver *
Comments or information for Coach Hope?
How did you find out about this program? *
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