Rising Stars Girls Club Application 2018-2019
Email address *
Mother’s name *
Your answer
Daughter's name and age *
Your answer
Additional daughter/participant's name and age
Your answer
Additional daughter/participant's name and age
Your answer
Home Address *
Your answer
Mother's Cellphone *
Your answer
Mother's Occupation
Your answer
Do you have any special talent you can share with the club (musical ability, special crafting, artistic or cooking skill etc...)?
Your answer
Emergency Contact (name, relation, number):
Your answer
The yearly fee is $60 for the first child, $50 for the second, and $40 for the third. You may pay by check (payable to Mariana Galvez) or Venmo @marianagalvez
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