PowerUp Girls for Life Program Registration

registration is now open for multiple events!


Greeley Family FunPlex

family-funplex logo.jpg

5TH GRADE PROGRAM

March 30th, April 6, 13, and 20

1:30 to 4:30 pm

1501 65th Avenue

Greeley, CO 80634


Windsor Middle School

5TH GRADE PROGRAM

Saturdays, April 13, 20, 27 and May 4

9 AM to noon

900 Main Street

Windsor, CO 80550

(Please email us for information, not the school)


Scott Elementary School, Greeley

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5th grade program

Host partner, Kimberlee Perales

Please contact Mrs. Perales at kperales@greeleyschools.org, or call 970-348-2243, for dates and information about her girls’ running program!


Registration Form for All Events

Before registering, please see the program page for more information.

Para registrarse en español, haga clic aquí.

Para información del programa en español, haga clic aquí.

Name of parent or guardian *
Name of parent or guardian
Each child must be registered by a parent or guardian
Name of participating student *
Name of participating student
Please provide her legal name. (You may include a preferred nickname in parentheses.)
Parent or guardian phone number *
Parent or guardian phone number
To be used in the event of an emergency
Additional emergency contact name *
Additional emergency contact name
Additional emergency contact phone number
Additional emergency contact phone number
Please fill in "none" or write in allergies to medications or foods
Which program location are you registering for?
T-shirt size
100% preshrunk cotton, Inches= dimensions of shirt laid flat
Name of parent or guardian signing consent form for child participation
Name of parent or guardian signing consent form for child participation
Your detailed consent to having your child(ren) participate *
By clicking this button, you agree that as the parent or guardian indicated above, you have read all the consent information provided below, have no questions or concerns, agree to all its terms, and hereby give permission for your child to participate in the program.
We do not want any child not to be able to participate so we don't charge a fee, but please consider donating to defray program costs and help us serve more children. A PayPal "Donate" link is below. Thank you!

AFTER FILLING IN the above FORM AND CLICKING the ORANGE "SUBMIT REGISTRATION" BUTTON:

Please consider making a small donation by clicking the orange “Donate” button to defray our costs, and help us serve more girls and develop more programs. No PayPal account needed. Just click the gray "Pay with debit/credit card" button while in PayPal. Thank you very much!

 
 

After we receive your form submission, we will notify you by e-mail.

Thank you!


PowerUp Girls for Life Consent Information

By indicating your consent for your child to participate in the PowerUp Girls for Life program while registering online (by clicking to fill the yes button on the consent question on the registration form), you verify the following:

1.    You are the parent or guardian of the child registered to participate.

2.    You have reviewed the detailed curriculum on the program page of the website, have read all the consent information here, and have no questions or concerns about your child learning about listed topics and other related topics.

3.    Your registered child is a 5th, 6th, 7th, or 8th grade girl.

4.    You understand that this program’s purpose is only educational and not therapeutic. If program facilitators identify a need that may benefit from psychological evaluation or therapy, referral information but not therapy will be given.

5.    You understand the following rules for participant conduct that will optimize the learning experience: respectful, non-disruptive behavior, following program facilitator directions, and keeping cellphones on silent and in a pocket or bag. If any of these rules are violated, you will be called to come and pick up your child.

6.    For programs hosted by the Youth Empowerment Group, you agree to have a parent or guardian sign in and sign out your child everyday at the registration desk and to pick up your child each day by 15 minutes after the program end time. Host partners may have procedures independent from ours and are at their discretion.

7.    You, the parent/guardian, will not hold program facilitators or venues liable for accidents or injuries. You will not hold the Youth Empowerment Group, volunteers, or any individual connected with the program liable for any accident, injury, or other harm to your child. Host partners are not affiliated with us, the Youth Empowerment Group, and you will not hold us liable for injuries, accidents, or any other event occurring at events held by host partners.

8.    Your child may be provided food and if she has food insensitivities or allergies, it is her responsibility to ask about ingredients in all food she chooses to ingest, and you have discussed this responsibility with her.

9.    You are aware that program facilitators including host partners are mandatory reporters of child abuse and neglect.

10.    You permit utilization of photographs or videos of your child taken during her involvement in the program at all sites for promotional purposes and waive all rights of compensation.

11.    One of our goals is to learn how to improve the program and assess how well we provide empowering life-skill education. By consenting, you agree to have your child participate in group verbal surveys and to fill out personal anonymous surveys during the program, indicating things such as understanding of the topics and enjoyment of the activities. You also agree to do a quick anonymous parent-guardian survey after the program. Lastly, you permit us to use summaries of any survey data or anonymous participant quotes in research studies, on our website, or in print materials, etc.