High School Initiative: Summer Registration
Girl's Name *
Your answer
Birthdate
MM
/
DD
/
YYYY
Address (including City, State, Zip Code)
Your answer
Grade as of August 12th, 2019 *
Your answer
School *
Your answer
T-Shirt Size (Adult) *
Does your child receive lunch assistance? *
Who does this child live with?
Number living in household? *
Your answer
Household Income Per Year
Primary Language Spoken at Home *
Race *
Required
Military Family *
Primary Guardian Name
Your answer
Primary Guardian Role *
Required
Primary Guardian Email Address *
Your answer
Primary Guardian Phone Number *
Your answer
Emergency Contact Info (Name, Phone, Relationship)
Your answer
Food/General Allergies *
Your answer
Parental Consent:
My girl will be attending the following weeks: *
Required
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