Girls who LEAD! Become Women of Influence!

Montgomery County

Name

Parent | Guardian

First Name

Last Name

Phone

(###)

###

####

Address

Annual Household Income

Data collected for grant purposes.

Name

Participant

First Name

Last Name

Message

Age of Participant

Date of Birth of Participant

Month/ Date/ Year

School of Participant

Grade Participant is Entering

T-shirt Size

Would you like information about Tuition Assistance?

Yes

Thank you for completing your Girls LEAD! Camp Registration. Registration will remain open through the first of June.