She Can Lead - Burlington Fall 2025

Session Information

For Girls in Grades

Session Start Date

Time

Duration

Location

Address

Session Details

Burlington | Grades 4 - 6 | Oct 9, 16, 23, 30, Nov 6, 13, 20, 27, Dec 4, 11 | 4:30pm - 5:30pm

Session ID

Child Information

Child's First Name

Child's Last Name

School Child Currently Attends

Grade

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

Secondary Contact

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 from parent phone number listed above.

Relationship to child

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)

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

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

If I am late picking up my child, a $5.00 for every 15 minutes may apply

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!

Email Details