Camps 4 Girls

(360) 878-2043

Olympia, WA

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Zoom Sessions Registration

3 Hour Empowerment Sessions

Saturday, April 11 from 12:00-3:00 pm
Saturday, April 25 from 12:00-3:00 pm

$50 for each Session or $95 for both

Information for how to log-on to the Zoom Sessions will be provided in a confirmation email once we've received your Registration.
Thank You for Zooming with us!

TO REGISTER:

Complete the Zoom Sessions Registration form on the right, including the Pre-Session Questionnaire.
Make your $50 nonrefundable deposit to reserve your space.

APPLYING FOR A SCHOLARSHIP?
Please complete our Scholarship Questionnaire to be considered for a scholarship for one or more Zoom Sessions, then return to this page and complete your registration.

Scholarship Questionnaire

QUESTIONS? Call or Email Kristen
(360) 878-2043
hello@empowerment4girls.com

Zoom Sessions Registration

* Indicates required field

Register for 1 or both 2-Hour Sessions. You can also choose to register for All 8 Zoom Sessions with this one form. *

April 11, 2020 April 25, 2020 Both Sessions, Please! All 8 Zoom Sessions

You can register for either session, or both at once.

Parent or Guardian *

First

Last

Person Attending *

First

Last

Age & Birth Date *

Address *

Line 1

Line 2

City

State

Zip Code

Country

If no Line 2, please enter x

Email *

Phone Number *

Pre-Session Questionnaire

Please take a moment and answer the following questions. All information provided will be stored securely. Personal information will only be shared with Empowerment 4 Girls Camp staff and pre-screened camp volunteers, as needed.
Click the (?) for detailed instructions for each question.

What is your Annual Household Income? *

$0-$16,910 $16,911-$25,750 $25,751-$34,590 $34,591-$43,430 $43,431-$51,500 $51,501-$60,340 $60,341-$69,180 $69,181-$77,250 $77,251-$86,860 $86,861-$103,770 $103,771-$117,030 $117,031-$130,290 $131,291-or more

Annual Household Income includes all income made by members of your household.

How many people are supported by your Annual Household Income? *

2 3 4 5 6 7 8

Include all people who are supported by your Annual Household Income.

Has anyone in the household become unemployed as a result of the Covid19 pandemic? *

Yes No

Comments regarding employment status: *

Racial Makeup of Household - Choose all that apply *

Alaska Native American Indian Asian Black Hispanic White

Providing this optional information supports our fundraising and program evaluation efforts.

Does your child exhibit any behavioral, emotional or developmental challenges? *

Anxiety Depression Suicidal Thoughts or Expression Aggression Toward Others Self-Harm Learning Disabilities None of the Above

Please let us know if your child has experienced any of the following:

Please explain above choices: *

Please explain your selection of the above items. For example, if you choose Learning Disabilities, please indicate what these are.

How do you think these sessions will benefit your child and your household? *

Also let us know if you think there will be benefits to others in your household.

What are some of the expectations you have in your child attending this session? Choose any that apply. *

Positive Body Image Become More Empowered Increase Confidence Stress Reduction Learn/Improve Yoga Techniques Increase Flexibility Build Strength Spiritual Growth Social Media Awareness Connecting with Others Needed a Place for My Child Other - Please Explain Below:

Explain other expectations *

Please explain the other expectations you had in choosing this camp for your child.

Is this child in the foster care system? *

Please let us know if this child is in the foster care system.

Payment

You will be asked for your payment on the next page after you click Register below.
You must pay a $50 nonrefundable deposit to complete your Registration.
Scholarship applicants please use the Session Scholarship option on the next page after you click on Register.

Register

Empowerment 4 Girls

A 501(c)(3) Nonprofit Corporation
EIN: 81-4391734
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Contact

Kristen Rubis
(360) 878-2043
hello@empowerment4girls.com

Mailing Address

3403 Steamboat Island Rd NW #493
Olympia, WA 98502

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We are so grateful for the businesses and individuals who so generously support us.

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