T-shirt size of girl participant: *

Medical Information

Does the participant have any known allergies or other health issues or is she taking any medication(s) which should be made known to a treating physician or other health care provider? *

Session Information

To participate in PositivelyMe! program, your child must be able to attend both days and stay for the full length of time. Please indicate which session she can attend in order of preference by marking a 1, 2, 3, or 4 next to each date (1=most preferred date) : *
* Junior League House- 231 EAST Putnam Avenue, Greenwich, CT 06380

Alternative Emergency Contact Information

* Name of Person(s) to notify in case of an emergency(if Parent/Guardian cannot be reached) 

Consent Form

**Signed release forms by a parent or guardian are required by the Junior League of Greenwich to participate in the PositivelyMe! program.**

Please click here and download the release form to complete and sign. 
Please click here to find the PositivelyMe! Code of Conduct form. We request that guardians review the PositivelyMe! Code of Conduct with the participant prior to the program. Once the guardian and participant are clear on the content, both must physically sign the document.
**These forms should be either scanned and emailed, or mailed.**
Forms can be mailed to:

Junior League of Greenwich
Attn: PositivelyMe!
231 East Putnam Avenue
Greenwich, CT 06380
Please confirm your preferred method of delivery for the forms. *
* Please note, a memory group photo of the girls will be taken. Do you give permission for other photographs with your child to be used for public relations materials? No names or school information will be included. *

One last thing...