Mailing Address & Phone Number
P.O. Box 1691
Lithia Springs, GA 30122
Phone: (404) 680-3419
Caring & Sharing Membership Application
*Indicates Required Fields
To be completed by student and parent/guardian.
1. Student Information
*First Name:
*Last Name:
*Age Grade Level
Date of Birth:
*Primary Phone Number:
Alternate Phone Number:
*Name of your School:
*Email Address:
*Confirm Email Address:
*Street Address:
Unit/Suite:
*City:
*State *Zip
*County:
2. Parent/Guardian Information
*First Name:
*Last Name:
*Primary Phone Number:
Alternate Phone Number:
*Email Address:
*Confirm Email Address:
*Who does the student live with?
Mother Father Both Guardian
If address is the same check here, and go to the Question #3
*Street Address:
Unit/Suite:
*City:
*State *Zip
*County:
*Parent's Employer:
Work Phone Number:
3. Marketing Question
Please help enhance our marketing efforts. How did you first hear about Caring & Sharing?Word of Mouth
Website or Search Engine
Brochure
Other
4. Getting to know you.
List up to 4 of your hobbies or interests:
Hobby/Interest 1:Hobby/Interest 2:
Hobby/Interest 3:
Hobby/Interest 4:
List up to 4 of your awards or achievements: Award 1:
Award 2:
Award 3:
Award 4:
List up to 4 teams or organizations that you are actively involved in: Group 1:
Group 2:
Group 3:
Group 4:
What are areas of self improvement that you are considering?
(i.e., attitude, grade, self-esteem, behavior, etc.) Area 1:
Area 2:
Area 3:
Area 4:
5. Why would you like to become a member of Stir It Up Girls?
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6. Caring & Sharing Member Policy:
Click Here to review and download the Caring & Sharing Member Policy.