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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 26–June 30 "Rub a dub, dub, what's that in the tub?"
Week 2 July 3-July 7 (Closed Tue. July 4) “Fireworks and Fireflies."
Week 3 July 10-July 14 “Myth Busters."
Week 4 July 17-July 21 “Oh, the Places You'll Go!"
Week 5 July 24-July 28 “Under the Big Top."
Week 6 July 31-August 4 "Sheroes."
Week 7 August 7-August 11 “LEGO Mania."
Week 8 August 14-August 18 “Shake, Rattle and Roll."
Please select which weeks you're able to attend.
Not AttendingStandard DayExtended Day
Week 1 June 26-June 30 “Through the Looking Glass.” (additional field trip fee of $15.00 applies)
Week 2 July 3-July 7, (Closed on Tuesday, July 4) “Green Gardening.” (additional field trip fee of $10.00 applies)
Week 3 July 10-July 14 “G Force.” (additional field trip fee of $30.00 applies)
Week 4 July 17-July 21 “Stem to Steam.”
Week 5 July 24-July 28 “On the Move.” (additional field trip fee of $50.00 applies - overnight trip 7/27-7/28)
Week 6 July 31-August 4 “It's Electric."
Week 7 August 7-August 11 “LEGO Mania.” (additional field trip fee of $10.00 applies)
Week 8 August 14-August 18 “Shake, Rattle, & Roll.”
Child's Information
Parent/Guardian 1
If applicable
Are you currently serving, or have you previously served in the military?
Parent/Guardian 2
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
Contact 2
Contact 3
Medical
I agree to update Girl Inc. of Worcester if there are any changes in the following information.
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 or Girls Inc. van 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 and electronic form and videos taken of my child during program to be used for public relations purposes in newsletters, brochures, annual reports and for publicity on our website, social media, radio, television and newspapers.
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 deposits are non refundable/ non transferable.
5. I acknowledge the availability of a grievance policy that is available upon written request.
6. I acknowledge additional field trip fees may apply.
Demographic Questions
All information provided will be kept confidential and will not be shared without your permission.