PowerUp Girls for Life Program Student Registration

Name of female student participant *

First Name

Last Name

Which program are you registering your child for? *

PowerUp Girls for Life (for girls only), June 10-14

PowerUp Co-Ed for boys and girls, July 8-11

Grade completed during the 2023-2024 school year *

5th grade

6th grade

7th grade

8th grade

Your phone number *

The primary phone to call or text with needed program or student information

(###)

###

####

Your name as this student's legal parent or guardian *

First Name

Last Name

Phone number of another adult responsible for your child

A second phone to call or text with needed program or student information

(###)

###

####

Please click the button below indicating you confirm that you have read the program overview document and have no concerns and that you have read and agree to all terms of the consent document and give consent for your child to participate in the program. *

Your yes answer here is required for your named child to participate. The documents referred to can be found by clicking buttons to the right side of this form.

Yes

Please indicate your registration fee payment amount *

After clicking the submit button, you should see a thank you page with links to payment options. If not, find them at the link right above this form. Completing payment is required before registration is complete.

$75 registration fee

$50 when registering by May 21st

Request free scholarship

Your legal name as a signature giving consent for the named child to participate *

Typing your name in this field constitutes a legal signature.

First Name

Last Name

Date

MM

DD

YYYY