Girls' Empowerment Group Afterschool Registration

Girls' Empowerment Afterschool Registration
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Parent Name*

First NameLast Name
Parent Name

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please describe any behavioral or health concerns
Creative Roots Refund Policy

Payment for programs which are cancelled by Creative Roots at any time will be refunded in full.

Registratants who cancel up to 1 week prior to the program will receive a partial refund of up to 80%.

Registrants who are not able to attend a program or who would prefer to register for another program at a later date, may be eligible to receive a credit towards Creative Roots programs.

Sign below to indicate that you have read the refund policy, and paid and received confirmation of payment.

Thank you
E-Signature*

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