Member Registration Form

Step 1 of 6 - Child

Child Information
Child's Name:*
First Last
Date of Birth:*
MM slash DD slash YYYY
Age:*
School:*
Grade this Fall:*

Primary Parent/Guardian Information
Name:*
First Last
Relationship:*
Address:*
Street Address Address Line 2 City State ZIP Code
Best Phone Number to Reach You:*
Phone Type:*
2nd Phone Number to Reach You:
Phone Type:
Email:*
Secondary Parent/Guardian Information
Name:
First Last
Relationship:
Address:
Street Address Address Line 2 City State ZIP Code
Best Phone Number to Reach You:
Phone Type:
2nd Phone Number to Reach You:
Phone Type:
Email:

Emergency Contact/Authorized to Pick Up
If Primary and Secondary Contacts Cannot Be Reached
Contact #1*
First Last
Relationship:*
Address:*
Street Address Address Line 2 City State ZIP Code
Best Phone Number to Reach Them:*
Phone Type:*
2nd Phone Number to Reach Them:
Phone Type:
Contact #2
First Last
Relationship:
Address:
Street Address Address Line 2 City State ZIP Code
Best Phone Number to Reach Them:
Phone Type:
2nd Phone Number to Reach Them:
Phone Type:

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