Registration - Fall 2017

Please note that registration is limited and will be accepted in the order payment is received.

Please download, print, and carefully read the HowGirlsCode Waiver and Hold Harmless Agreement prior to registering your child.  HowGirlsCode Waiver and Hold Harmless Agreement (pdf)

Course Selection *
Please select the course you are registering your child for.
About Your Child
Address *
Address
Please select your student's t-shirt size. T-shirts are not guaranteed, dependent on sponsor donations.
School Information
Select the school your student currently attends.
If you selected "None of the Above," please tell us the name of your school.
Grade *
Put n/a if your child doesn't attend the school where the class is being held.
Before and After-Care *
Does your child attend before or after-care on the day of this class at the school where the class is being held?
About Primary Parent/Guardian
Primary Parent Name *
Primary Parent Name
Primary Home Phone *
Primary Home Phone
Primary Cell Phone *
Primary Cell Phone
About Secondary Parent/Guardian
Secondary Parent Name
Secondary Parent Name
Secondary Parent Cell Phone
Secondary Parent Cell Phone
About Emergency Pick-Up
Please provide the name and contact information for someone we may call in the event of an emergency if the primary or secondary parent/guardian cannot be reached.
Emergency Pick-Up Name *
Emergency Pick-Up Name
Please describe the relationship between the child and the emergency pick-up.
Emergency Pick-Up Cell Phone *
Emergency Pick-Up Cell Phone
About Medical Concerns
Medical Information *
Does your child have any limitations or medical conditions that could affect their participation in this class?
Please explain if you answered yes above. Be sure to include asthma and allergy information.
Parental Consent Forms/Waivers
Photography/Media Release Form *
I grant to HowGirlsCode the right to take photographs of my child during their after-school programming. I authorize HowGirlsCode to copyright, use and publish the same in print and/or electronically. I agree that HowGirlsCode may use such photographs of my child with or without their name and for any lawful purpose, including for example such purposes as news articles, publicity, illustration, advertising, and Web content. Examples of how we use photography online and via twitter can be seen here: http://www.howgirlscode.com/news-and-updates/ .
Acceptance of Waiver and Hold Harmless Agreement *
I accept the Waiver and Hold Harmless Agreement. See the PDF link at the top of this page for details.
Late Pick Up Policy *
Please read and accept our Late Pick Up Policy: Thank you in advance for ensuring that your child is picked up on time. In the event of excessive wait time for pick up, the following policies will apply: After one late pick up of 15 minutes or more, there is a $5.00 fee for the first 15 minutes, and $10 fee for the second 15 minutes and each succeeding 15 minute time segments. After 45 minutes, we will reach out to the emergency contacts to request pickup. After two late pick ups of 15 minutes, we will contact you to discuss terminating your child's participation in the course.
Demographics
Ethnicity
One of our goals is to ensure we are providing programming to a diverse group of girls. Please indicate your ethnicity.

Click "Submit" to complete registration and continue to the payment page. 
(All courses must be paid for to complete and secure registration.)

Need-based scholarships are available on a first-come, first-served basis. Scholarships cover up to 75% of registration fees. If you would like to request a financial assistance, please complete this form and our Program Assistant will be in touch with you.