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Forms

Registration for Girls

Conference for Girls and Young Women

OLD Dominion University

Community Development Corporation

Saturday, June 2, 2012

8:00 am - 2:00 PM

Continental Breakfast and Lunch Provided

Student Registration

Special Assistance Needed

Tee Shirt Size:

Type of Meal

Workshops

Ages 14-18

A. "Beautiful Leaders"

B. "Body Talk (known as Lady in the mirror)"

C. "Relationship Reality Show"

D. "Smart Money"

Ages 10-13

A. "Diva 2.0"

B. "Financial Literacy"

C. "Loving You and Doing Me"

D. "Sugar and Spice But That's Not So Nice"

Registration is on a first come, first serve basis. You will be placed in your 1st choice unless the workshop is already full.So, please be sure to make an alternate choice.

Parental/Guardian Consent

*Some workshops during the conference may require parental consent for participation. Please read and check 'YES' below as a form of parental consent and signature giving your child permission to attend those sessions. No exceptions allowed. (If you are a sponsor bringing a group of girls each girl is required to complete a separate registration form.)

,hereby certify that I am the parent and/or legal guardian of

do hereby give my consent for his/her participation.

Media Release Consent

As a form of signature check "YES" below stating: I give permission that my child may be filmed/photographed/interviewed by the media during this conference and herby authorize the use of my child's image/photograph/voice for promotional and educational purposes (including but not limited to brochures, booklets, videotapes, reports, press releases, web sites, and exhibits).