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Summer Programs Online Registration Form

All weeks are full for ages 4-6 except week 2.
Please select which weeks you're able to attend.
Not AttendingStandard DayExtended Day
Week 1 June 25-June 29, “Shipwrecked.” - FULL FOR AGES 4-6
Week 2 July 2 – July 6 (Closed Wednesday, July 4), “Fizzle, Sizzle, Pop.”
Week 3 July 9 – July 13, “Creepy, Crawly, Bug Week.” - FULL FOR AGES 4-6
Week 4 July 16 – July 20, “Color me Crazy.” - FULL FOR AGES 4-6
Week 5 July 23 – July 27, “Watcha Eating?” - FULL FOR AGES 4-6
Week 6 July 30 – August 3, “Adventures in Space.” - FULL FOR AGES 4-6
Week 7 August 6 – August 10, “Bubble Mania.” - FULL FOR AGES 4-6
Week 8 August 13 – August 17, “We’ve Got the Beat.” - FULL FOR AGES 4-6
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
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)
Sunscreen
Parents/guardians should provide spray-on sunscreen for use during the camp day. Sunscreen sent to camp, preferably the spray type, should be placed in a sealed plastic bag and labeled with the child’s first and last name. In the event your child does forget her sunscreen, Girls Inc. does have a limited supply of spray-on sunscreen available for us. Parents/guardians are responsible for applying the first layer of sunscreen prior to morning drop-off and provide it for use during the camp day. During the camp day, staff will take all reasonable and appropriate steps to help each child reapply sunscreen using spray-on sunscreen only to exposed skin– including the face, the tops of ears, and bare shoulders, arms, legs, & feet– prior to campers’ participation in outdoor programs. Each child is responsible to rub in the sunscreen in areas that are reachable on their own after it has been sprayed. Staff is able to help children in hard to reach areas including the shoulders and back if it is exposed with parent/guardian permission.
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.