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Rites of Passage Institute

Girl's Crescent (age 11-14) Rites of Passage Registration Form

* Indicates required field

Parent's/Caregiver's Name 1 *

First

Last

Email *

Parent's/Caregiver's Name 2 *

First

Last

FB Name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Best Way to Reach You *

Phone Email Facebook

Participating Child's Name *

First

Last

type your daughter's name who will going through the rites of passage

Age of Participating Child *

Participating Child's Name *

First

Last

Age of Participating Child *

Participating Child's Name *

First

Last

Age of Participating Child *

Participating Child's Name *

First

Last

Age of Participating Child *

Do you have any knowledge or skills you would like to share/contribute to the Rites of Passage *

Yes No Maybe

Any information or skills you want to teach the girls or facilitators.

Would you like to donate any material for the Rites of Passage? *

Yes No Maybe

paper, plastic letters, glue, paint, chalk, magnets, contact paper, small baby plastic pool, etc

Please list names of any possible volunteers, useful connections, or resources. *

Please list material for possible donation if you like. *

What do you expect to gain from the Girls' Rites of Passage? *

What do you and your daughter want to accomplish, what do you expect from us???

Any suggestions, comments, questions, concerns, etc *

I understand that when a child is going through a Rites of Passage the parents are going through a rites of passage too. Therefore, I understand that this program requires my full participation.This is not a drop off activity. I expect to be present at all meetings. *

Yes, I agree. No, I do not agree.

I'm aware that I may be exposed to information concerning individuals that is of a personal and confidential nature. I agree that this information will not be disclosed to any third party. *

I Agree I do not agree

Confidentiality Agreement.What happens between the participants stays between the participants within the Rites of Passage Program.

Submit

TELEPHONE NUMBER

1-877-570-3108