AFTER SCHOOL PROGRAMS

2019 AFTER SCHOOL PROGRAMS

Fall 2019 | Spring 2020

After School Leadership Academy

• Six week program

• Weekly session at the school

• $130 per session

Locations

Audubon Park K-8 School

every Tuesday from January 7th through February 11th

3:00 p.m. – 4:30 p.m.

Lake Whitney Elementary

every Monday from September 30- November 4^th 3:00 p.m. – 4:30 p.m.

Participant's Information
Fall After School will be at Lake Whitney
Participant's Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
School Name
Shirt Size
Please choose a shirt size for your camper.
Current Grade
Select the current grade for the 2018-2019 school year.
How will participant get home?
Add Additional Participant?
Participant 2 Name
First Last
Parent / Guardian Information
Parent / Guardian Name
First Last
Home/Main Phone Number
Email
Address
Street Address Address Line 2 City State ZIP Code
Additional Parent / Guardian Information
(optional)
Add Additional Parent/Guardian?
Name
First Last
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Health Information
Pediatrician’s Name
Phone
Family Medical/Hospital Insurance
Policy Number
Group Number
Allergies
Emergency Contact in Parent’s Absence
Name
First Last
Emergency Number
Alternate Phone Number
Relationship to Participant
Our Policies
Permission/Waiver/Release I, the undersigned, as the parent or legal guardian of the participant, give permission for her to participate in activities offered by Leadership 4Girls. I know of no medical, physical, mental or emotional condition that would hinder or prevent her participation in the Leadership 4Girls program. I waive any claim of liability against, and agree to hold harmless Leadership 4Girls and any other officer, agent and/or employee thereof from any claim of injury to participant arising out of or in any way connected with any class or activity offered by Leadership 4Girls. Permission to Provide Necessary Treatment or Emergency Care If I cannot be reached in a medical emergency, I give permission to the medical care provider(s) selected by Leadership 4Girls to secure and administer all necessary treatment, including hospitalization, for the participant. Photography , Video Recording and Program Evaluation Any picture, recordings, video footage, any images moving or still and/or writings will belong to Leadership 4Grils and may be used for advertising and promotion. I understand that Leadership 4 Girls conducts evaluations to assess the quality of programs. I give permission for my daughter to be part of this program evaluation. I also understand that the information collected about my daughter will be kept confidential and her name will not be associated with the results. Refunds and Cancellations Written requests for cancellation may be made 21 calendar days prior to the camp, minus a $25 processing fee. Cancellations after this time will be honored when there are extenuating circumstances such as participant illness. I have read, understand and agree with the Permission/Waiver/Release, Consent for Emergency Medical Treatment, Photo and Video Recording, Program Evaluation and Refunds and Cancellation policies.
After School Program
Price: $130.00
L4G After School will be held at Lake Whitney Elementary. 1351 Windermere Rd Winter Garden, FL 34787. If you have any questions, please call or text Cindy at 321-946-1629 or Email at cindy@leadership4girls.org
Number of Participants*
Please enter a number greater than or equal to 1.
Total
$0.00

Save and Continue Later

Participant's Information
Spring After School will be at Audubon Park School
Participant's Name
First Last
Date of Birth
Date Format: MM slash DD slash YYYY
School Name
Shirt Size
Please choose a shirt size for your camper.
Current Grade
Select the current grade for the 2019-2020 school year.
Add Additional Participant?
Participant 2 Name
First Last
Parent / Guardian Information
Parent / Guardian Name
First Last
Home/Main Phone Number
Email
Address
Street Address Address Line 2 City State ZIP Code
Additional Parent / Guardian Information
(optional)
Add Additional Parent/Guardian?
Name
First Last
Phone
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Health Information
Pediatrician’s Name
Phone
Family Medical/Hospital Insurance
Policy Number
Group Number
Allergies
Emergency Contact in Parent’s Absence
Name
First Last
Emergency Number
Alternate Phone Number
Relationship to Participant
Our Policies
Permission/Waiver/Release I, the undersigned, as the parent or legal guardian of the participant, give permission for her to participate in activities offered by Leadership 4Girls. I know of no medical, physical, mental or emotional condition that would hinder or prevent her participation in the Leadership 4Girls program. I waive any claim of liability against, and agree to hold harmless Leadership 4Girls and any other officer, agent and/or employee thereof from any claim of injury to participant arising out of or in any way connected with any class or activity offered by Leadership 4Girls. Permission to Provide Necessary Treatment or Emergency Care If I cannot be reached in a medical emergency, I give permission to the medical care provider(s) selected by Leadership 4Girls to secure and administer all necessary treatment, including hospitalization, for the participant. Photography , Video Recording and Program Evaluation Any picture, recordings, video footage, any images moving or still and/or writings will belong to Leadership 4Grils and may be used for advertising and promotion. I understand that Leadership 4 Girls conducts evaluations to assess the quality of programs. I give permission for my daughter to be part of this program evaluation. I also understand that the information collected about my daughter will be kept confidential and her name will not be associated with the results. Refunds and Cancellations Written requests for cancellation may be made 21 calendar days prior to the camp, minus a $25 processing fee. Cancellations after this time will be honored when there are extenuating circumstances such as participant illness. I have read, understand and agree with the Permission/Waiver/Release, Consent for Emergency Medical Treatment, Photo and Video Recording, Program Evaluation and Refunds and Cancellation policies.
After School Program
Price: $130.00
L4G After School will be held at Audubon Park School. 1500 Falcon Dr Orlando, FL 32803. If you have any questions, please call or text Cindy at 321-946-1629 or Email at cindy@leadership4girls.org
Number of Participants*
Please enter a number greater than or equal to 1.
Total
$0.00