Join Wilderness Girls

Wilderness Girl's Name

Date of Birth

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent's/Guardian's Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email

Phone

Allergies or Medical Conditions

e.g. asthma or epilepsy

Special Dietary Conditions

Additional Physical or Emotional Support Conditions

e.g. physical disabilities, Autism, ASD, ADHD

I allow my child to be photographed during Wilderness Girls events.

Yes
No

I agree to have my phone number shared with other Wilderness Girls parents.

Yes
No

Girls be Address

By signing, I agree to the holding of this information and understand the Wilderness Girls will not pass information onto third parties without prior permission. The information I have provided is correct as of the date signed.

Signature

Clear Signature

Date