Sunnyvale Week 2 Girlstart Summer Registration

Primates and cacti and fish, oh my! Bring the relationship between animals and plants to life as you engineer a circuit bug and design a unique axolotl habitat. Create a glider that soars with the birds, learn about bioluminescence, and program a turtle-saving device. From tiny terrariums to elephant adaptations, campers will use STEM to explore their favorite living things!

Girlstart is excited to offer a FREE week-long summer 'Wild World' session!

Girlstart's summer programs are completely FREE for 4th-5th grade girls in your school thanks to the generosity of our supporters. We are proud to recognize and celebrate our sponsors here: https://girlstart.org/support-girlstart/our-donors/

We have a limited number of spaces in Girlstart's 'Wild World' session. You will be contacted within 2 business days with a confirmation email or waitlist email. If you are on the waitlist, Girlstart will reach out if spaces become available.

Wild World

Who: 4th-5th grade students

When: July 14-18

Time: 8:30 am - 3:30 pm

Camper Drop-off: 8:15 am - 8:30 am

**PLEASE DO NOT DROP OFF YOUR CHILD EARLIER THAN 8:15 AM

Camper Pick-up: 3:30 pm

Where: Columbia Middle School (739 Morse Ave, Sunnyvale, CA 94085)

Student Information

Student First Name

Student Last Name

School District

School

Date of Birth

mm/dd/yyyy

Grade Level in the 2025-2026 School Year

3rd

4th

5th

General Information

For reporting purposes the following six questions are optional:

Please indicate your student's race (select all that apply):

Please Indicate your student's ethnicity:

Hispanic/Latino

Not Hispanic/Latino

Primary language spoken in your home:

Select from the list or type it in if not shown.

Is your student receiving (or eligible for) free or reduced lunch at school?

Yes

If/when your student attends college, would they be the first in your family to attend college?

Yes

How many people are living in your household?

This is the first time my student is participating in Girlstart.

Yes

If no, please select all that apply.

My student has participated in Girlstart After School in the past.

My student has participated in Girlstart Summer Camp.

My student did a Girlstart activity at a school's science/family/etc. night

How did you hear about Girlstart Wild World?

In Case of Emergency

Parent First Name

Parent Last Name

Parent E-Mail Address

Parent Cell Phone

Phone

Work Phone Number

Phone

Home Address

City

State

Zip Code

During the hours that Girlstart is in session, if I cannot be reached in the event of an emergency, the following adult is authorized to act in my behalf:

Emergency Contact Name

Relationship to Student

Cell Phone

Phone

Work Phone

Phone

All known food and/or drug allergies:

Any medical conditions or learning disabilities of which we should be aware:

Program Agreement

Girlstart is excited to provide this summer program enrichment opportunity for your child! To ensure that each and every participant has a great experience, we want all of our participants and parents to understand and be familiar with the expectations for participating in our summer programs. Please read and share the expectations below with your student.

Expectations

I will attend Girlstart for the week I am registered.
I will follow all expectations established by myself and fellow Girlstart participants on the first day of the program.
I will be responsible for my actions and behavior so that it doesn’t interfere with somebody else’s opportunity to enjoy Girlstart.
I will work through all activities, even if they are challenging and ask questions if I need help.
I will cooperate with my counselors and fellow Girlstart participants in all activities.
I will act and speak positively and kindly to all Girlstart participants and staff (i.e., no swearing, inappropriate remarks, etc.).
I will listen and not talk when others are talking because I want them to do the same for me.
I will have FUN, make FRIENDS, and LEARN new things all week long!

Parent/Guardian Signature

By entering your name below, you are effectively providing your signature, acknowledging that you and your student are aware of the expectations and understand that you must adhere to this agreement, as well as any policies added by Girlstart staff or faculty throughout the duration of the summer program. Non-compliance may result in the dismissal of your student from the program.

Student Signature

Type full name

Permission Form

Media Consent

I understand that as a part of Girlstart, my child/ward may be videotaped, audiotaped, interviewed, and/or photographed and agree to allow Girlstart to keep, as Girlstart’s property, the products of such videotaping, audio taping, interviewing, and/or photographing and I agree that such material, along with my child’s name may be used, and posted on the Girlstart Website, for promoting the Girlstart program and in any publicity generated by Girlstart. I also understand that my child/ward may be asked to do or participate in projects that may also be used by Girlstart for publication in a variety of forums including the Girlstart newsletter, website, and other publications, and that no compensation will be paid for such use. Additionally, I understand that Girlstart participants will receive a souvenir framed group picture of everyone from their session.

Please select one of the three options:

OPTION A: Yes, I give permission for pictures or videos of my child/ward to be used on official Girlstart marketing materials and social media.

OPTION B: My child/ward may participate in the group photo, but I do not give permission for this photo to be used on official Girlstart marketing materials or social media. Additionally, Girlstart will not take any other photos of your participant throughout the week. Only Girlstart participants and your partner location administration will receive a printed copy of the group photo.

OPTION C: No, my child/ward may not participate in Girlstart photos of any kind. I understand my child/ward will not be in the framed group photo received at the end of the program.

Option A

Option B

Option C

My child/ward has my permission to participate in Girlstart's summer program.

I understand that by participating in Girlstart, my child/ward becomes part of a program/study concerning girls and their attitudes toward math and science. I hereby grant permission for my child/ward to participate in this program/study. I further understand that Girlstart will only release the information in accordance with Girlstart policies and procedures.

I understand that participating in Girlstart allows my child/ward no special rights or expectations regarding Girlstart, including the right to sue any party involved in the implementation and execution of the Girlstart programs. I agree to hold harmless Girlstart, their agents and employees from all claims, damages, losses, injuries and expenses arising out of or resulting from participation in these activities. I further agree not to sue Girlstart, their agents and employees for any actions or causes of action, including the negligence of Girlstart arising out of participation in this program.

Parent/Guardian Signature

By entering your name below, you are effectively providing your signature, allowing your child/ward to participate in Girlstart's summer programs and indicating that all the information on this form is true and accurate to the best of your knowledge.

Anti-Discrimination Policy

Girlstart is an organization committed to equity and accessibility. Our anti-discrimination policies can be found on our website at www.girlstart.org/get-in-touch.

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