Girls on the Run of the Bay Area: ENROLL

Programs: Enroll

Enroll | Curriculum | Locations | Start a Program

The Spring 2012 Season

The program begins the week of February 27 and ends on May 12. The finishing Lollipop 5k Run will be held on 5/12/2012 at Golden Gate Park in San Francisco.

Programs are offered throughout the bay area each fall and spring. Most programs meet on school campuses and are only open to students enrolled at those schools. The Community Programs are open to all girls regardless of which schools they attend. Enrollment is limited to 16 girls per program. The standard registration fee is $225 and includes 20 sessions, healthy snacks, T-shirt, water bottle, journal, and Lollipop 5k Race entry. Some schools qualify for reduced program costs; please check to see if you think your school qualifies

Scholarships
All girls are welcome to participate in our programs regardless of financial means. Our policy is to never turn away a girl. Please first register your daughter online below and then complete the scholarship application form on the following page.

Payment
If your program requires payment, please know that we can accept program payment in the form of checks, cash or credit card.

Step 1 of 5: Enter Participant Information:

*Girl's First Name:

*Girl's Last Name:

*Address:

(include Apt # if applicable)

*City:

*State:

*ZIP:

*Home Phone:

*Date of Birth:

Ethnicity:
Optional, but helpful for grant funding.

*Girl's School Name:

*Girls on the Run Program Site:
See Program Locations & Times >>

*Girl's Grade in School:

*Girl's T-shirt size:

Has your daughter participated in Girls on the Run before?

Where does your daughter go after Girls on the Run? (home, tutor, after-school program, grandparent's house, etc.)

Step 2 of 5: Enter Parent/Guardian & Emergency Information

*Parent/Guardian First Name:

*Parent/Guardian Last Name:

Address:

(If different from girl's))

City:

State:

ZIP:

*Email:

*Phone:

Alternate Phone:

Employer:
Optional, but may be very helpful in securing grants or sponsorships.

Occupation:
Optional, but may be very helpful in securing grants or sponsorships.

Emergency Contact Information

*Emergency First Name:

*Emergency Last Name:

*Relationship to Girl:

*Emergency Phone:

Emergency Alternate Phone:

Step 3 of 5: Enter Health Information

Girl's Pediatrician:

Phone:

Family Medical/Hospital Insurance

Policy/Group Number:

Health History

Any other major health problems or allergies? (if yes, please list)

Use of prescription drugs?
(if yes, please list)

Does the child live with or spend a lot of time with someone who smokes cigarettes?

Does the child have close relatives (mother, father, brother, sister) who have a history of heart disease?

Step 4 of 5: Waiver and Permission

WAIVER OF LIABILITY AND PERMISSION TO PARTICIPATE
I, the undersigned, give permission for my child to participate in the activities offered by Girls on the Run of the Bay Area. I know of no physical disorder that could keep my child or ward from participating in this program. I waive any claim of liability against, and agree to hold harmless Girls on the Run of the Bay Area, and any other officer, agent and/or employee thereof from any claim of injury to participant arising out of or in any way connected with any class or activity offered by Girls on the Run of the Bay Area.

Further, if said participant should become injured while participating in a program, I authorize transportation to any physician or surgeon licensed in the State of California to perform emergency or surgical treatments, which, in his or her judgment, may be necessary.

I understand that Girls on the Run of the Bay Area conducts evaluations to assess the quality of programs. I give permission for my child to be part of this program evaluation. I also understand that the information collected about my child will be kept confidential and that only the persons connected with Girls on the Run of the Bay Area and the evaluation will have access to this information.

I also give permission for any photograph, videotape, film audiotape or writing of said participant, obtained during normal after-school activities, to be used in informational materials for Girls on the Run of the Bay Area.

I also give permission for my child to participate in off-campus practices at nearby parks, to attend field trips organized by Girls on the Run of the Bay Area, and to use the transportation arranged for the purpose of field trips.

* I accept

PERMISSION TO PROVIDE NECESSARY TREATMENT OR EMERGENCY CARE
I hereby give permission to the medical personnel selected by Girls on the Run of the Bay Area, including without limitation, coaches, volunteers and staff to provide transportation and all necessary medical and dental care for the above-named child. I hereby give permission to the medical care provider(s) selected by Girls on the Run of the Bay Area to secure and administer all necessary treatment, including hospitalization , for the child. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of the child.

* I accept

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