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.
* Required
Which Drop-In Site will your child be attending programming at?
*
Damiano Center (Begins Oct. 14th) Monday's 3:30-5:00 PM
AICHO (Begins Oct. 9th) Wednesday's 4:30-6:30 PM
Boys & Girls Club (Pending dates/time)
Valley Youth Center (Pending start date) Wednesday's 6:00-7:45 PM
NYS/Washington Center (Pending start date) Friday's 2:00-4:00 PM (Youth) 5:30-7:00 PM (Teens)
Other:
Child's Name
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
School & Grade
*
Your answer
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.
Your answer
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!
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
Two Parents
Mother Only
Father Only
One Parent at a Time
Foster Care
Grandparent(s)
Other:
Language(s) spoken at home:
English
Spanish
Chinese
Ojibwe
Arabic
Other:
Please mark ALL races that apply to this child:
White/Caucasian
Black/African American
Native American/Alaskan Native
Asian
Native Hawaiian Pacific Islander
Hispanic Origin
Other:
Comments and Signature
Submit
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