Girl Empowerment 3 Day Camp
Event Timing: June 17-19, 2019
Event Address: Orangeburg City Gym, 410 Broughton Street, Orangeburg, SC
*$25 one-time registration fee REQUIRED and is non-refundable* Payment must be received no later then June 3.

Contact Person: Jeanette Brown at 202-236-3663 or thesafeorg@yahoo.com

This event is for girls ages 11-17. The purpose of this event is to inspire, empower, encourage and educate girls to be who they are created to be. We will have special guest speakers, food, games, prizes and more.

Youth Information
Youth Name
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Address
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Phone #
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Grade
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Age
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Medical Condition
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Food Allergies
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T-shirt Size
Parent/Guardian Information
Parent/ Guardian Name
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Phone #
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Email
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Emergency Person & Phone Number
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Photograph Authorization
I hereby grant to S.A.F.E. and its representatives the irrevocable and unrestricted right and permission to use and publish photos of me, or my child, in which may be included for education, illustration, promotion, or other purpose in any manner or medium, and to use my name in connection therewith.

I hereby release the S.A.F.E. Organization and its representatives from all claims and liability relating to said photographs.

I am of legal age and have read the aforementioned and fully understand the contents thereof.

Parent/ Guardian Signature & Date *
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Liability Waiver
My child has permission to participate in the Girl Empowerment Day. I will not hold the SAFE Organization, Orangeburg City Gym and/or Sponsors for any injury that occur.
Parent/ Guardian Signature & Date *
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Do we have permission to talk to your daughter about the following topics: love, sex, relationships and female reproductive system? *
Payments
This is a one-time payment of $25 for all three days. All payments is non-refundable. Lunches and t-shirt are included in the registration fee.

Payment must be received no later then June 3.

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