Full Name:
Date of Birth:
Age: —Please choose an option—9101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960
Gender: Female ONLY
School Participant Attends:
Street Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
Parent/Guardian Full Name:
Relationship to Participant:
Emergency Contact 1 Full Name:
Emergency Contact 2 Full Name:
Does the participant have any allergies or medical conditions we should be aware of? If yes, please specify:
Current medications (if any):
Primary Physician's Name:
Physician's Phone Number:
I hereby grant permission to Sweenee Gurls Inc. to use photographs, videos, or other media of the participant for promotional purposes, including but not limited to publications, websites, news, and social media platforms.
Initials:
How did you hear about Sweenee Gurls Inc.?
Is there anything else you would like us to know about the participant?
I, understand that participation in Sweenee Gurls Inc. programs may involve physical activity and give permission for my daughter/ward to participate. I agree to release Sweenee Gurls Inc., its staff, and volunteers from any liability for injuries or damages that may occur during participation in the program.
Signature:
Date:
