Girl Unleashed Program Sign Up Form

Please complete this form to enroll and participate in the Girl Unleashed program and have the chance to join free hiking experiences and adventure camps. Please review the email sent to you after the form submission to complete your enrollment process.

Applicant's Name

First Name

Last Name

Date of Birth

YYYY

Participant's Phone Number

(###)

###

####

Participant's Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which activities are you most excited about?

Group hikes

Virtual skills classes

Summer camp

Annual high peak mountain hike

With which race/ethnicity do you most identify with?

Select an option

School's Name

What is your shoe size?

What is your T-Shirt size?

What is your pants size?

Have you ever hiked?

Have you been camping?

Parent/Legal Guardian's Name

First Name

Last Name

Parent/Legal Guardian's Email

Parent/Legal Guardian's Phone

(###)

###

####

What is the best way to contact parent/legal guardian?

In order to tailor our health services to better suit your needs, please indicate if you have asthma:

Have you ever experienced a seizure, or are you currently being treated for any type of seizure disorder?

Is there anything else you think we should know about your medical background?

If you have any questions or concerns please write them here.

Please note that to take part in theprogram, you must confirm that:

You are 18-years of age, or you have parental or guardian consent.
You are free of any major physical, mental or emotional disability that could prevent you from fully participating in our program, and physically fit to be able to engage in; hiking, climbing, bouldering, kayaking, backpacking expeditions, snowshoe hiking, skiing, etc.
Like many physically engaging outdoor activities, there is a risk of physical injury, and you fully accept responsibility for all such risks as a condition of participation.

Girl Unleashed Program Sign Up Form

Please note that to take part in theprogram, you must confirm that:

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info@girlunleashed.org