Register for She Can be Media Savvy! 

Session Name

Registration Closed

YesNo

Session at Capacity

YesNo

Session Information

For Girls in Grades

Session Start Date

Time

Duration

Session ID

Location

Address

Participant Information

Participant's First Name

Participant's Last Name

School Child Currently Attends

Grade

Please select... 5 6 7

Birthdate (mm/dd/yy)

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Email Address

Street Address

Town/City

Postal Code

Participant Medical Information

Does your participant have any medical conditions, allergies or medications we should know about?

YesNo

Please provide additional medical information (including if your child has a puffer or epi-pen)

Secondary Contact First Name:

Who should we call if we can't reach you?

Secondary Contact Last Name:

Secondary Contact Phone Number (Must be different than Phone Number above):

Relationship to child

Please select... Parent/Guardian Friend Aunt Uncle Grandparent

I understand that the She Can! Girls Empowerment Programs are for girls (inclusive of cisgender and transgender girls) and nonbinary youth.

If I am late picking up, a $5 fee for every 15 minutes may apply.

I grant MCRC permission to use photos of my participant on their social media accounts, website, and on promotional materials. (Optional) 

I would like to be added to the She Can! Email Mailing list. (Optional) 

Would you like to make a donation to support She Can! Girls Empowerment programs?

NoYesPlease Note:  This She Can! program is 100% free to attend and a donation is not required to participate.

Donations

She Can! programs rely on grants, fundraising and donations to continue this important work. Making a donation today would enable us to continue to provide the much needed program supplies to girls in our community for our upcoming programs.
Click here to make a She Can! donation!

Notice

This session is now full, thank you for your interest.

We’ll now be collecting demographic information once a year—stay tuned for more soon!