THR!VE Bronze for Teen Girls Registration Form
Daughter's Information
Daughter's First Name*
Daughter's Last Name*
Daughter's Birthdate*
Daughter's Age*
Daughter's School*
Daughter's Grade (or equivalent, if homeschooled)*
Daughter's Allergies / Dietary Restrictions / Health Conditions*
THR!VE Bronze Course Selection
Individual "Coffee Shop" Mentorship & Social Media Connection*

Daughter's Social Media Connections
Please list any and all ways you permit THR!VE staff to connect with your daughter for the purpose of mentorship: cell phone number, email address, Facebook account, etc.
"Sit Awhile With Me" Group Contemplations: Growing Up With Grace & Gratitude*

"Who I Am" Personal Strategic Planning: What Learning, Living & THR!VING Is All About*

Nature's Peace: The Woods & Their Wisdom*

Public Speaking & The Written Word: Back to the Basics of Strong Communication*

Special Interest Trip Series (choose 3 of 4)
Creative Genius: Visual Art & Music

World Cuisine Dining

Beyond Biology: The Astounding Sciences of Life

Beachcomber's Paradise

Community Service Trip Series (choose 2 of 3)
Remembrance & Respect: The War Veterans of Camp Hill

Giving Hope Today: The Community Service Impact of The Salvation Army

Physical & Mental Health: Supporting Those Who Suffer

Health, Hobbies & Happiness Series (choose 2 of 3)
Story Worlds: The Enchanted Lands of Literature

Exercise & Nutrition: A Fresh Perspective

Planet Earth: Its People & Places

THR!VE Bronze Graduation Gala & Reception*

Parent Information
Parent First Names*
Parent Last Name*

Address 1

Address 2




Postal Code
Primary Phone*
Secondary Phone
Please provide a primary email address where you wish to receive all THR!VE correspondence.
Parent Occupations / Business Affiliations
This field is optional, but can help THR!VE identify potential new trip destinations, guest speakers, small business partnerships, etc. We like to get to know our families!
Please list the Facebook names of any relatives or friends you wish to be tagged in photos and videos of your daughter's THR!VE adventures:
Payment & Permissions
I will provide a deposit of $750 by/before August 31 (including a minimum of $250 with this registration to secure my daughter's spot), followed by 10 monthly payments of $275 - on the 1st of each month - from September 2017 through June 2018. I intend to provide payments in the following manner:*
Credit Card
Credit Card Number
Credit Card Expiry
Credit Card CVC (3 digits on back)

Permissions (please carefully read and check all)*