EHA Registration Form

Enrollment Registration

Annual registration
Admission Requirements:
• Female age 6-17 years.
• Reside in Georgia
• Schedule date/time to complete Registration Package

Attendance:
• Mentees are required to attend all meetings: Bi-Weekly (Saturdays) In person / Virtually every Wednesday evening via Zoom or Google Meet.
• If meetings are canceled/postponed parents will be notified accordingly and given a rescheduled date
• Excessive tardiness and absences will result in removal from the program

Annual Registration Fee/Monthly Dues:

1 Child (Annual Enrollment Fee) $100

*Monthly Dues $30

2 Children (Annual Enrollment Fee) $170

*Monthly Dues *60

3 Children (Annual Enrollment Fee)$210

*Monthly Dues $90

**Registration Deposit invoice will be sent once registration form is submitted

Registration Fee(s) are non-refundable.
Parent Name 1*

First NameLast Name
Parent Name 2

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Number of Children
Child's FULL name*
Child's age*
Any allergies?
Child #2 FULL name
Child's age
Any allergies?
Child #3 FULL name
Child's age
Any allergies?
Which Chapter location are you interested in?*

Athens,GA & Surrounding AreasAugusta,GA & Surrounding AreasOther
Signature - I have reviewed the Policies & Procedures of Encourage HER Academy (EHA) as provided on the website. Additionally, I am aware that a nonrefundable deposit is required at the time of sign-up.*

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Signature: I acknowledge that upon my child's official acceptance, there will be monthly dues required to support the maintenance of the program. *

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Should be Empty:

Enrollment Registration