Member Registration Form

Step 1 of 7

Child Information

Name(Required)

First Last

Date of Birth(Required)

Age(Required)

School(Required)

Grade for 2023/24 school year(Required)

Primary Parent/Guardian Info

Name(Required)

First Last

Relationship to child(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best phone # to reach you at(Required)

Type of phone

Second phone # to reach you at(Required)

Type of phone

Email(Required)

Secondary Parent/Guardian Info

Name

First Last

Relationship to child

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best phone # to reach you

Type of phone

Second phone # to reach you at

Type of phone

Emergency Contact if Primary/Secondary Guardians Cannot Be Reached

Emergency Contact #1: Name(Required)

First Last

Relationship to Child(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best # to reach contact(Required)

Type of phone

Second phone # to reach contact

Type of phone

Emergency Contact #2: Name

First Last

Relationship to child

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Best phone # to reach contact

Type of phone

Second phone # to reach contact

Type of phone

Testimonials

I wasn't born in Richmond and I had a hard time making friends; Girls Inc. enable me to make friends. Girls Inc. has really helped my life and I really enjoyed going there for plenty of reasons. I feel bad because this is my last year and I wish I could continue to come or at least work there. Girls Inc. and their staff mean a lot to me.
JaMarie

Bold is my word because I do try my hardest, I am outgoing, I love kids and people in general, I get involved with new activities and complete my tasks. It takes being strong and smart to become a bold outspoken young woman and I plan on being the same bold (sort) of person for the rest of my life. Thanks to Girls Inc. I can be.
Naomi

My favorite thing about Girls Inc. was the way (my girls) talked about it at the end of the day, full of stories about what they learned and did.
Parent