Participant Application

We're excited to have her. This form gives us what we need to keep her safe, plan her group, and reach you quickly if anything happens.

It takes about 15 minutes. Have her doctor's phone number and your insurance card nearby.

A parent or legal guardian must complete this form. Fields marked required must be filled in.

1 — About your daughter

First name (required)

Enter her first name.

Last name (required)

Enter her last name.

Name she goes by (if different)

Grade this school year (required)

Select her grade.

School she attends (required)

Enter her school.

Has she attended Maker Girls before? (required)

New Returning

Please choose one.

How did you hear about Maker Girls? (optional)

2 — Parents and guardians

All Maker Girls communication goes to the adults listed here. We do not contact girls directly.

Primary parent or guardian

First name (required)

Required.

Last name (required)

Required.

Relationship to participant (required)

Required.

Mobile phone (required)

Required.

Email (required) This is how we send confirmations, reminders, and updates.

Enter a valid email address.

Second parent or guardian (optional but recommended)

First name

Last name

Relationship

Mobile phone

Home address

Street address (required)

Required.

Apartment, unit, etc. (optional)

City (required)

Required.

State (required)

Required.

ZIP (required)

Required.

3 — Alternate emergency contact

If you list an alternate contact, choose someone other than a parent or guardian who can be reached during club times if we cannot reach you.

Emergency Contact is Different from Parent or Guardian

First name (required)

Required.

Last name (required)

Required.

Relationship to participant (required)

Required.

Phone (required)

Required.

4 — Pick-up and release authorization

We check photo ID before releasing any girl to an adult who isn't already known to our team. List everyone who might collect her so nobody gets turned away.

Authorized adult 1 — name and relationship (required)

Name at least one authorized adult.

Authorized adult 2

Authorized adult 3

Authorized adult 4

Is there anyone who must not pick her up? (required) This includes anyone named in a custody order, parenting agreement, or order of protection.

No Yes

Please answer this question.

Who, and what should we know? If a court order is in place, please email a copy to kirstie.gvl@makergirlsbydesign.com. We keep it confidential and share it only with the staff who need it.

5 — Health and medical

Snacks are served at every session, and activities involve needles, scissors, and sewing machines. Please tell us everything we'd need to know in a hurry.

Does she have any food allergies or intolerances? (required)

No Yes

Please answer this question.

List each food and what happens For example: “Peanuts — hives and swelling, severe. Dairy — stomach upset, mild.”

Any other allergies? (required) Insect stings, latex, medications, animals, or anything in the environment.

No Yes

Please answer this question.

List each one and what happens

Any medical conditions, EpiPen, or inhaler we should know about? (required) Include asthma, diabetes, seizure disorder, heart conditions, migraines, or anything else that could come up during club.

No Yes

Please answer this question.

Please describe each condition and include any EpiPen or inhaler location and emergency instructions

Does she take medication during club hours (4:00–6:00 pm)? (required)

No Yes

Please answer this question.

Which medication, what dose, and when?

Anything that would help a mentor support her well? (optional) An IEP or 504 plan, sensory sensitivities, anxiety, ADHD, hearing or vision needs, or simply what helps her have a good day. This stays with the staff who work with her.

Physician and insurance

Physician or clinic name (required)

Required.

Physician phone (required)

Required.

Health insurance carrier

Policy or member number

Approximate date of last tetanus shot (optional) We ask because club activities involve needles, pins, and scissors.

6 — Emergency medical authorization

If my daughter is injured or becomes ill during a Maker Girls program and I cannot be reached immediately, I authorize Maker Girls staff and volunteers to:

— call 911 or seek emergency medical care;
— arrange transport to a hospital or urgent care;
— give the treating provider the health information on this form; and
— consent to examination and treatment that a licensed provider judges necessary until I can be reached.

I understand Maker Girls will make every reasonable effort to contact me and my emergency contact first, and will notify me as soon as possible.

I authorize emergency medical care as described above

This authorization is required for your daughter to participate.

7 — Photographs and video

Answer each one separately. You can say yes to some and no to others, and you can change your mind at any time by emailing us.

Internal use (required) Recap slideshows shown at club, and photos shared privately with Maker Girls families.

Yes No

Please answer.

Website and printed materials (required) Our website, brochures, and newsletters.

Yes No

Please answer.

Social media (required) Instagram and Facebook. Once posted publicly, images can be copied and shared beyond our control.

Yes No

Please answer.

May we use her first name with a photo? (required) We never publish last names, schools, or any other identifying detail.

Yes No

Please answer.

8 — How we keep her safe

Our commitments to you

Mentors have no contact with girls outside of club. No texting, no calling, no direct messaging, no social media contact. Everything comes to you.
Every regular volunteer aged 18 or over is background checked before her first session, provides two references, and is an active member of a local church.
Volunteers complete mandated reporter training. Under Illinois law this means that if a volunteer has reason to believe a child is being abused or neglected, she is legally required to report it to the authorities. We want you to know this up front.
We check photo ID before releasing a girl to any adult our team doesn't already know.
Your daughter's information stays with the staff who need it. See the privacy note below.

I've read how Maker Girls keeps girls safe, including that volunteers are mandated reporters

Please confirm you've read this section.

9 — Program agreement

I understand club meets every Monday, 4:00–6:00 pm, in person, September through May I understand Maker Girls is a Christian program that includes Bible study and teaching about Jesus at every sessionGirls of any faith background, or none, are welcome. We simply want you to know what she'll hear. I've talked with my daughter about treating other girls, mentors, and the space with respect I understand Maker Girls isn't responsible for personal items that are lost or damaged

All four boxes must be checked.

Acknowledgment of risk. Club activities include the use of sewing machines, needles, pins, scissors, and craft materials, along with games and movement. I understand there is a risk of injury in these activities and that Maker Girls takes reasonable steps to supervise and reduce that risk.

I understand and accept the ordinary risks of these activities

This acknowledgment is required.

10 — Your daughter's information

What we collect and why. Everything on this form is used to run the program safely: to plan groups, serve snacks that won't harm her, reach you quickly, and release her only to the right adult.

Who sees it. Only Maker Girls staff and the volunteers who work directly with your daughter. Health information is shared only with the mentors who need it, and with medical providers in an emergency.

What we don't do. We never sell your information, and we never share it with anyone outside Maker Girls except where the law requires it.

How long we keep it. For as long as your daughter participates and for seven years after she leaves the program. To ask what we hold or request deletion, email kirstie.gvl@makergirlsbydesign.com.

11 — Signature

Full name of parent or legal guardian (required)

Please type your full name.

Typing your name here acts as your electronic signature.

Today's date (required)

Please enter today's date.

I am the parent or legal guardian of the girl named on this form, the information I've given is true and complete, and I intend my typed name above as my signature

This confirmation is required.

Anything else you'd like us to know? (optional)

Leave this blank

We'll confirm by email within about a week. Questions? Email kirstie.gvl@makergirlsbydesign.com.

Thank you

We've received your application and we'll be in touch by email within about a week with next steps.

If anything on the form changes before then — a new phone number, a new allergy, a change to who can pick her up — email kirstie.gvl@makergirlsbydesign.com and we'll update her record.