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Registration Form

What We Do

IMPORTANT: You must make at least one payment in order to secure a girl's spot in our program. Filling out this form does not guarantee she is enrolled. You may make a payment by clicking here.

Spring Break must be paid in full by March 15 in order for girls to participate in that program.

To apply for the Eureka! program, click here

Please select which program(s) you wish to register for:
Girl's Information
Mother's Information
Father's Information
Guardian's information (if other than parent)
Emergency Information
I hereby give my permission for my daughter to leave the Center under the supervision of the Center Leader for any activity within walking distance and/or using Girls Inc. transportation. I will not hold Girls Inc. responsible in case of an accident. I understand that if the girls leave the meeting place, notice of where they are going will be posted. They will return within meeting time unless prior notification is given.
How did you hear about Girls Inc.?
Girls Inc. has my permission to use photos of my daughter(s) in publications.
I received and read the Parent Handbook. I agree to abide by rules for members and parent conduct.
I understand that Girls Inc. may offer age-appropriate programs on the following subject matters: alcohol abuse, chemical abuse, human sexuality, sexually transmitted diseases, mental diseases, mental health sessions, inter-personal relationships, and value clarification. I hereby give permission for my daughter to participate in these educational programs.
I understand Girls Inc. is not responsible for loss of personal property.
I understand Girls Inc. often evalulates progress of participants in projects whose value to girls is being studied. I hereby give permission for my daughter to participate in these evaluations or studies. Information which identifies my daughter cannot be revealed unless I sign a release form for that purpose.
I understand that there are NO REFUNDS provided for membership and fees from Girls Inc. of Central Alabama.
Participation Fact Sheet

Information is confidential and needed for reporting purposes only and will be used anonymously. Please assist us by checking all the appropriate boxes.

My girl's racial/ethical background is:
My girl lives with:
Is your daughter on a free or reduced lunch plan?

Please note: Your child's place in our program is not confirmed until payment arrangements have been made. You will be given the option to pay in full by credit card now on the next page. If you would like to pay by check, please make it out to Girls Inc. of Central Alabama and mail to:

Girls Inc. of Central Alabama
P.O. Box 130729
Birmingham, AL 35213

If you have questions regarding payment plans, please email Angela Eakins or call (205) 599-5545.