GIRL ZONE Fall 2020 Registration Form
Thank you for your interest in Girl Zone's virtual out of school time program for the Fall of 2020.
Girl Zone is open to girls and femme identified youth between the ages of 8 to 18.
Email address *
Girl Zone Application Checklist
To complete the application process, please review all sections of this application checklist carefully:

1. Girl Zone Registration Form
2. Signed Assumption of Risk, Release & Consent to Participate Agreement
3. Signed In-Person Programming Waiver (Possible Spring 2021)
4. Attend Virtual Mandatory Parent Orientation

After completing this form, a Girl Zone educator will follow up with you to provide further information on our platform.
Virtual Parent Orientation dates are as follows: Wednesday, August 26 at 7pm and Saturday, August 29 at 11am.

For questions please contact our Program Manager, Vikki Ramirez at 210.557.7287 or at victoria@mswomenscenter.org
Girl Zone Program Schedule
Our Monday - Friday Programming as follows:

Monday WokeShop 4-6 pm (Elementary School) | 4-6 pm (Middle School)
Tuesday Homework Help 4-6 pm (All Ages)
Wednesday Virtual Family Activity (No ES & MS Zoom) | 4-6 pm (High School)
Thursday Homework Help 4-6 pm (All Ages)
Friday WokeShop 4-6 pm (Elementary School) | 4-6 pm (Middle School)
Girl Zone Registration Form
Student Full Name
Gender Pronoun
Student ID/Lunch Number
Student Date of Birth
MM
/
DD
/
YYYY
Student Age
Student Ethnicity/Race
If you answered 'Other', please explain
Student School
Student School District
Student Grade 2020-2021 School Year
Guardian Full Name
Relationship to Student
Guardian Phone Number (List all that we can reach you at)
Guardian Email Address
Highest Level of Schooling Completed by Guardian
Are you a single parent or grandparent?
Clear selection
Home Address
Zip Code
Number of People Living in Household
How many youth under the age of 18 are living in the Household
Is there internet at your home?
Clear selection
If you answered 'Yes' to the above question, is your internet access wifi or smart phone?
Clear selection
What is your monthly household income? (optional)
Emergency Contact (Must be different that guardian listed above)
Emergency Contact Phone Number
Any additional notes you want Girl Zone to be aware of?
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