up co mi n g cal en d ar...of durham programming. i give my consent f or her t o part icipat e in f...
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GIR
LS
INC
. HQ
1-3
98
BAYLY
ST
. W
AJAX
, ON
L1S
1P1
COST
:
$25
/ M
ONTH
FOR
MEM
BERS
$40
/ M
ONTH
FOR
NON
-MEM
BERS
905
-428
-8111
GIRLS INC OF DURHAM
@girlsincdurh
am
@girlsincdurh
am
Upcoming Calendar
GIRLSPACE
GIRLS WILL DEVELOP LEADERSHIPSKILLS AND PARTICIPATE IN ACTIVITIES
THAT BUILD SELF-CONFIDENCE ANDHEALTHY COMMUNICATION.
Topics Include:
Operation SMART (STEM)
Allies in Action (Anti-Bullying)
Mind+Body
Leadership
FOR GIRLS AGES 6-12
WEDNESDAYS IN JANUARY ,MARCH AND MAY
6 :30-8 :30 PM .
to register check out our website
WWW.GIRLSINC-DURHAM.ORG
Where we inspire all girls to be strong, smart, and bold!
Subsidies
available
upon
request
Program PermissionI herby grant permission for my child________________________________________ to participate in Girls Inc. of Durham programming. I give my consent for her to participate in field trips and neighbourhood outingsarranged by the staff at Girls Inc.of Durham. Parents will be notified in advance of any such trips and may beasked to provide additional support depending on the outing. I understand that my daughter may be transportedby vehicle or walking, with adult supervision, in order to arrive at the destination. I understand that my medicalcoverage is the primary insurer for my child and will not hold Girls Incorporated of Durham responsible in case ofan accident or injury.
Parent/Guardian Signature: ____________________________ Date:_____________________
Media Release There will be occasions where pictures or videos of your daughter will be taken to be used in media projects forthe purpose of our program. These photos may also be used for public relation purposes, newsletter, brochures,annual reports, radio, television newspapers and our home website. o I give my permission for my daughter toappear in any Girls Inc. of Durham publications.
____ I give my permission for my daughter to appear in any Girls Incorporated of Durham publications.
____ I do not give permission for my daughter to appear in any Girls Incorporated of Durham publications
Signature: ____________________________ Date:_____________________
Registration FormChild's Name:____________________________________________________________________________Birthdate: M_____ D_____ Y_____ Age:_____ School:_________________________________Grade:_____Please indicate any medical information that you would like us to be aware of i.e. food allergies, medications,conditions etc._______________________________________________________________________________________Main ContactName:_______________________________________Relationship to Child: _________________________Address: __________________________________________________________ City: _________________Postal Code: __________ Home Phone: _______________________Cell Phone_______________________Email___________________________________________________________________________________Alternative/Emergency Contact Name:_____________________________Phone:______________________
Girls Inc. Membership Single $55 Family $70 Girls Inc. Members receive a 20% discount off of all programsMember Weekly $25 for 4 weeks Non Member Rate $40 for 4 weeks
___ GirlSPACE ___ GirlZONE ___ Membership
Location: Ajax _____ Payment Method: Cheque Cash Credit Card #_________ _________ __________ __________Expiry Date_________/________Name on Card: _____________________________Where did you hear about us?__________________________________________ ETAP TRAX