Drop In Sites for Girl Power! 19-20
Please fill out the following form in order to register your child for Girl Power! at one of our drop in sites. Girl Power! is geared towards 3rd-8th grade female identifying students and moving towards high school aged programming as well. Staff will contact families when/if changes are made. Some sites are still pending start dates/times/and schedules, please be patient and you will be contacted as decisions are made.

Please do not send your child to Girl Power! programming until you have received a confirmation call and/or packet from YWCA Girl Power! staff.

We will contact you as soon as possible after receiving submitted form. Call or email Saraiya Piantek,  Program Coordinator 218-722-7425 x108 or Saraiya@ywcaduluth.org with any questions.
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Which Drop-In Site will your child be attending programming at? *
Child's Name *
Birthdate *
MM
/
DD
/
YYYY
School & Grade *
Medical Conditions *
Please list any medical conditions/medical needs/allergies/physical limitations that may affect your child at Girl Power! and any applicable care that we should know about.
Please mark YES or NO for the following: *
Yes
No
My child has attended Girl Power! before
A relative or friend of my child has attended Girl Power!
Family configuration living with this child
Language(s) spoken at home:
Please mark ALL races that apply to this child:
Comments and Signature
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