2019 Sparkle Summer Empowerment Program for Girls
The information submitted below will be used for communication purposes only. This does not secure your space in the summer program. Once you submit your deposit, that will officially secure your space in the program. A link to register for the summer program will be given after you fill out this information. If you have any questions, please email Kimberly Thomas at sparkleclubinfo@gmail.com.
Parent/Guardian Name *
Your answer
Parent/Guardian Email *
Your answer
Student Name *
Your answer
Age *
Your answer
Grade as of September 2019 *
Your answer
School *
Your answer
Date of Birth *
Your answer
Address *
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City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone Number *
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Parent's Mobile Number *
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Emergency Phone Number *
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List those authorized to pick up your child *
Your answer
Physician's Name & Number *
Your answer
List any food allergies, health issues, or physical limitations. *
Your answer
T-Shirt Size *
Your answer
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