Girl Society Intake Form Participant Name * First Name Last Name Email Phone (###) ### #### Age * Age Birthday MM DD YYYY Tribe Tribally Enrolled Federal State Don't Know Not enrolled Other Affliations Clan, other tribes, etc Guradian/Caretaker Name First Name Last Name Guardian/Caretake email Gaurdian/Caretaker Phone (###) ### #### Date MM DD YYYY Staff/Mentor Name who completed this form First Name Last Name Thank you!
