GIRL Spring Break STEAM Camp 2019
Hosted by Girls Inspired & Ready to Lead, Inc. in partnership with STEM exCEL

Fashion Illustration
For 6th- 8th Grade Girls
April 15-19, 2019 | 9:00 a.m. – 4:00 p.m.
STEM exCEL Enrichment Center in Fairfax City

To confirm your spot in the camp, please mail a check to made payable to GIRL to PO Box 7251 Fairfax Station, VA 22039.
$150 per girl

Please e-mail info@girlsinspiredinc.org for scholarships.

Email address *
Participant's First Name *
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Middle Name
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Last Name *
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Grade *
School *
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Parent's First Name *
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Parent's Last Name *
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Parent's E-mail *
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Parent's Home Phone Number *
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Address Line 1 *
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Address Line 2
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City *
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State *
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Zip *
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Work *
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Work phone
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Cell Phone *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Does the camper have any special needs or medical issues we should know about? Please explain any medical issues. *
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Please describe any allergies and/or diet restrictions the camper has below (i.e. nut allergies, vegetarian, etc.) *
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How did you hear about this camp? *
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Please list any individual who is authorized to pick up your child, including yourself. Authorized person may be requested to show ID to program staff. *
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Please list doctor’s name and phone number. *
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“In consideration of my [and/or my child(s)] participation in this activity, I hereby release and discharge the Organization, and its representatives, successors, and assigns, from any and all liability arising from accident, injury, and illness that I (he/she) may suffer as a result of my (our) participation in this activity. I (we) also will follow the rules and regulations set by the Organization and above named parties. Parent or guardian must sign for anyone age 18 and under. *
I do hereby grant and give these groups the right to use my or my child(s) photograph/video or image, both singly and in conjunction with other persons or objects and presentations, advertising, publicity, and promotion relating thereto. *
A copy of your responses will be emailed to the address you provided.
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