GirlStrength Registration

* Required Field GirlStrength Registration
Student Information
Student's Name
Age
Grade
Camp / Workshop Location
Parent / Guardian Information
Parent / Guardian Name
Address
Telephone
Email
Emergency Contact Person
Relationship
Telephone
Pickup Information How will your child be picked up after class?
Parent, Public Transportation, Picked-up by someone else, walking, etc.
If picked up by someone else: please provide name and relationship.
Please provide any additional information that you think we may need to maximize your child’s learning and experience in the program:
Photo Release The GirlStrength Program has my permission to use my child’s photograph publically to promote the GirlStrength program. I understand that the images may be used in print publications, online publications, presentations, websites and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such youth.
	Yes No
Parental Consent I hereby agree to hold harmless the Portland Police Bureau, GirlStrength, their employees and volunteers in this program. I certify that my child is fit to participate in all program activities. In case of emergency, I grant permission for my child to be given treatment at a local hospital.
Signature: (Type your Full Name)

The City of Portland, Oregon