The Glow Collective™

Member Application

Membership is 100% free for every young girl. Fill out the form below to officially join The Glow Collective™.

After submitting, every girl becomes an official member and receives:

✨Welcome Email
🎓Membership Certificate
📬Glow Newsletter
🎉First Event Invite
🎂Birthday Recognition
📲Program Updates

Student Information

First Name*

Last Name*

Age*

Grade*

School*

Date of Birth*

Parent / Guardian Information

Parent / Guardian Name*

Phone Number*

Email Address*

Home Address*

Preferred Communication Method *

Program Interests

Select all programs your daughter is interested in:

Emergency Contact

Emergency Contact Name*

Relationship to Student*

Emergency Contact Phone*

Health & Logistics

Allergies / Medical Information

Does your daughter need transportation assistance? *

Photo & Media Release

The Kaci Foundation may photograph or video record participants during events and programs. These images may be used for promotional materials, social media, and our website. Do you grant permission for your daughter to be photographed or recorded?

Parent / Guardian Signature

By typing your full name below, you confirm that all information provided is accurate and that you give permission for your daughter to participate in The Glow Collective™ programming offered by the Kaci Foundation.

Parent / Guardian Full Name (Signature)*

Date*

Membership is 100% free. Your information is kept confidential and used only for program purposes.

Glow Girl Membership Application — Kaci Foundation