Sister to Sister Summit 2010 Registration Form

Registration Deadline: November 12, 2010

If you need assistance with transportation, please call Judi Kirk at 508-791-3181, ext. 3022.

Sister Information

Girl's Name: *

Address:

City:

State:

ZIP:

Age:

Grade:

School Name:

Parent/Guardian Information

Parent/Guardian Name: *

E-mail: *

Address:

City:

State:

ZIP:

Relationship:

Phone:

Parent Preview:

Sign me up! Parent Preview, November 17, 2010

Emergency Information

Emergency Contact:

Reachable on the day of the event.

Relationship:

Phone:

Medical conditions/allergies we should be aware of:

Questionnaire

1. What do you think are the 3 most important issues/struggles facing girls today?:

2. Does cyberbullying happen at your school?:

Yes

If so, have you been a victim of it?:

Yes

3. I feel good about the way my body looks and feels.:

Yes

If yes, what do you like best? If no, why don’t you like your body?:

4. Have you ever been in a physical fight with another girl?:

Yes

If so, what was the fight about?:

5. If you could tell adults one thing about being a girl today what would that be?:

6. If you could design a program for girls your age what would it look like?:

By participating in the Sister to Sister Summit, you are allowing Investing In Girls to publish any and all pictures they take of you at this event.

Parent/Guardian Consent: *

I have read the information provided about the Sister-to-Sister Summit and consent to my daughter's participation on November 20, 2010 at Quinsigamond Community College, 670 West Boylston Street, Worcester

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22.9% of girls have been in a physical fight at least once this year

Learn more: Youth Risk Behavior Survey

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info [at] investingingirls [dot] org