Registration

FALL 2022 SHE’S GOLD REGISTRATION

STEP ONE:

Click button below to submit $100 program fee. We value our service, commitment, and financial investment in our programs. We take pride in
offering quality programming and outstanding experiences for each boy we mentor. We believe that when the parents are invested the children will be invested as well. However, we understand the financial responsibilities, economic hardships, and effects of the global pandemic. Approval for financial assistance will reduce your enrollment fee. Once approved we will send you a payment request. If you’d like to apply for financial assistance please email dareena@icementors.org. Please still complete the program registration.

STEP TWO

Please complete this form below. Once registration reaches capacity a waitlist will become available.

First Name *

Last Name *

Current Grade *

Zip Code

Age *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent Phone Number *

Student Phone Number

Parent Email *

Student Email

What school does she attend?

How did you hear about the program?

Please list any food allergies.

Is your daughter self-motivated and focused?

Yes

I confirm that my daughter is available to commit to the assigned dates and will complete the program to its entirety. I also give permission for her to be photographed for activities and professional use. I agree that Image Character Etiquette Inc. is not liable or responsible for damaged, stolen or loss items while with us. In addition, we are not liable for any body injuries. If an emergency occurs parents will be contacted first for instructions.

Yes