Girls inc of sarasota county

after school

enroll now for summer camp sessions
After School Program begins August 18, 2008 - REGISTER NOW!

The Girls Inc After School Program is for Girls in Grades K-8.

  • Features Include:
  • Transportation to our center from approximately 22 area schools.
  • Girls Incorporated National Programs offered daily.
  • Homework assistance provided
  • Kids Cafe – hearty, nutritious snack
  • Field Trips
  • Full day sessions when schools are out (included in monthly tuition)
  • Fee Schedule:
  • Registration $25 (non-refundable)
  • After-school program $115 per month
  • 25% Sibling Discounts

Please Fill out the form below, or download the registration form PDF

Membership Application and Information Form
2009 - 2010
What program(s) are you interested in?
After School Summer Programs
 
How did you hear about our program?
Friend     Family     School     Staff    
 
Do you need financial aid?
Yes No

Member Information:
 
First Name:
Last Name:
Birthdate:   Age:
  
Race:
Address:
City:
State:   Zip:
  
School:
Grade:
 
NEXT

Parent Information:
 
Mother's Name:
Phone:
(Work)
(Cell)
Address:
City:
State:   Zip:
  
Place of Employment:
Occupation:
Email:

 
 
Father's Name:
Phone:
(Work)
(Cell)
Address:
City:
State:   Zip:
  
Place of Employment:
Occupation:
Email:

 
 
Legal Guardian: (if applicable)
Phone:
(Work)
(Cell)
Address:
City:
State:   Zip:
  
Place of Employment:
Occupation:
Email:
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Household Income and Information:
Does your child receive Lunch Assistance?
Free Reduced
 
Who does this child live with?
Parents     Mother     father     Grandparent(s)
 
Household Income:
 
Do you speak another language other than English at home:
Spanish

Member Information:
 
Doctor's Name:
Doctor's Phone:
 
Should participant’s activities be limited because of any health problem(s) such as allergies, previous surgery, etc? If so, please list and describe:
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Special Needs and Concerns:
(Please Check if Applicable)
 
Custody issues:
Yes No
 
Special Medical:
Yes No
 
Special Disabilities:
Learning Development Emotional
Mobility Visual Hearing
Physical Multiple
Are there any particular situations/events etc. that "set off" behaviors that cause concern, such as hiding, tantrums, biting, pants wetting, hitting, etc.?
Yes No
 
If yes, please describe
 
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Emergency Contact Information:
If parent(s) / guardian cannot be reached in case of emergency, who should be contacted:
 

Emergency Contact 1
Name:
Relation:
Phone:
(Work)
(Cell)
 

Emergency Contact 2
Name:
Relation:
Phone:
(Work)
(Cell)
 

Release Information:
 
MY CHILD MAY BE RELEASED TO:
 
MY CHILD MAY NOT BE RELEASED TO:
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*Notice: Girls Inc. of Sarasota County will not share your personal information with outside parties.



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