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Summer Programs Online Registration Form

Please select which weeks you're able to attend.
Not AttendingStandard DayExtended Day
Week 1 June 25-June 29, “Shipwrecked.”
Week 2 July 2 – July 6 (Closed Wednesday, July 4), “Fizzle, Sizzle, Pop.”
Week 3 July 9 – July 13, “Creepy, Crawly, Bug Week.”
Week 4 July 16 – July 20, “Color me Crazy.”
Week 5 July 23 – July 27, “Watcha Eating?”
Week 6 July 30 – August 3, “Adventures in Space.”
Week 7 August 6 – August 10, “Bubble Mania.”
Week 8 August 13 – August 17, “We’ve Got the Beat.”
Please select which weeks you're able to attend.
Not AttendingStandard DayExtended Day
Week 1 June 25 – June 29, “Project ‘Funway.’”
Week 2 July 2 – July 6 (Closed Wednesday, July 4), “Turning Back the Clock.”
Week 3 July 9 – July 13, “The Game of Life...Twists & Turns.”
Week 4 July 16 – July 20, “Investigate & Navigate.”
Week 5 July 23 – July 27, “Watcha eating?”
Week 6 July 30 – August 3, “Energizing.” (extended hours on FT day)
Week 7 August 6 – August 10, “Green Spaces.”
Week 8 August 13 – August 17, “We’ve Got the Beat.”
Child's Information
First Name
Last Name
Generational
Parent/Guardian 1
Title
First Name
Middle name(s)
Last Name
Generational
If applicable
Are you currently serving, or have you previously served in the military?
Parent/Guardian 2
Title
First Name
Middle name(s)
Last Name
Generational
If applicable
Are you currently serving, or have you previously served in the military?
Emergency Contacts & Authorized Pick-Ups
In case of Emergency, Parents/Guardians are always contacted first
Contact 1
Title
First Name
Middle name(s)
Last Name
Generational
Contact 2
Title
First Name
Middle name(s)
Last Name
Generational
Contact 3
Title
First Name
Middle name(s)
Last Name
Generational
Medical
I agree to update Girl Inc. of Worcester if there are any changes in the following information.
Title
First Name
Last Name
Credentials
Allergies (If none, put N/A)
Medications
If yes, for what reason(s)
Please list any additional information that you would like us to be aware of (all information is both confidential and helpful to the adult in charge of your child)
Girls Inc. of Worcester Activity Permission
1. I give permission for my child to participate in Girls Inc. programs and to be transported by bus, Girls Inc. van or walk to and from these activities, field trips, and school centers. I understand that my medical coverage is the primary insurer for my child and will not hold Girls Inc. responsible in case of an accident.
2. I give permission for images in print, electronic form and videos taken of my child during program, as well as my child’s name, to be used for public relations purposes in newsletters, brochures, annual reports and for publicity on our website, social media, radio, television, newspapers and by our community partners.
3. I am aware there is a late fee of $15.00 for each 15 minutes that I am late to pick up my child.
4. Any and all payments are non-refundable/ non-transferable.
5. I acknowledge the availability of a grievance policy that is available upon written request.
Demographic Questions
All information provided will be kept confidential and will not be shared without your permission.