I am registering: * Myself + My Daughter (please complete entire form) My Daughter (please complete entire form) Myself (please omit the "Girls" fields) Parent Name First Name Last Name Parent's Email * Parent's Phone (###) ### #### Parent's Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Girl's Name First Name Last Name Girl's School Girl's Age Girl's Grade Emergency Contact First Name Last Name Emergency Contact's Email Emergency Contact's Phone (###) ### #### Please list any dietary restrictions or food allergies of any attendees? If no restrictions or allergies, write NONE Please let us know if any attendee has any special accommodations (accessibility, hearing/visual assistance, etc.)? If no accommodations, write NONE Contact Us: mosaic.summit1@gmail.com | 315.399.0591