Crowned and Confident – Program Registration

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Crowned and Confident is a 4-week virtual leadership and confidence-building program for Black girls ages 10–12. The program focuses on self-worth, voice, emotional awareness, and early leadership development in a safe and culturally affirming space.

Parent/Guardian Full Name *

Parent/Guardian Email Address *

Parent/Guardian Phone Number *

Preferred Method of Contact *

Phone

Text

Participant Information - Full Name *

Participant Information -Age *

Child's Grade Level

What are you hoping your child gains from Crowned and Confident?

Technology & Participation - Will your child have access to a device with internet for virtual sessions?

Yes

Not Sure

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Consent & Agreement (REQUIRED) *

I understand sessions are facilitated by Black Girls in Blazers, Inc

I understand my child may appear on screen during sessions

I understand sessions will not be publicly recorded or shared

I agree to support my child’s attendance and respectful participation

Parent/Guardian Signature (Typed Name)

Date

Thank you for registering for Crowned and Confident!
A member of the Black Girls in Blazers team will contact you with program details, session dates, and virtual access information.

👑 Confidence starts from the crown.

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