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Register for Programs

To register for a program, complete the registration form below. You may also download the form (Word) or download the form (PDF) and drop it off with the applicable fee at 125 Providence Street. Additional forms may be required depending on the program you are registering for. Please note, there is a registration fee of $25 for girls in grades K-12.

All payments are non-refundable and non-transferable.

For more program information, please contact 508-755-6455.

Child's Information
My child is eligible to receive
Is there a parent or guardian actively serving in the Military?
How will your child get to Girls Inc.?
Parent/Guardian 1
If applicable
Parent/Guardian 2
If applicable
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.
I give permission for my child to receive emergency treatment and to be hospitalized at my expense, if necessary. I understand that every effort will be made to contact me before taking this action. I also agree to update Girls Inc. of Worcester if there are any changes in the following information.
Girls Incorporated 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 deposits are non refundable/ non transferable.
5. I acknowledge the availability of requesting copies of background checks, healthcare policies, discipline policies, and procedures for filing grievances. .
Demographic Questions
All information provided will be kept confidential.