Special Program Registration

Thank you for registering. Please fill out the additional liability release, and the photo release (optional).

Parent Name *
Parent Name
Child's date of birth
Child's date of birth
Will your child be wearing glasses at this event?
Has your child attended a Girls Build event before?
Emergency contact name *
Emergency contact name
Emergency contact phone number *
Emergency contact phone number
Second emergency contact name *
Second emergency contact name
Second emergency contact phone *
Second emergency contact phone
Are you registering a second child?
Second child's name
Second child's name
Second child's date of birth
Second child's date of birth
Will your second child be wearing glasses?