Purple is a young ladies group promoting the well-being of young women ages 11-21.

Call: 407-292-6500 or 407-860-7744

JOIN NOW!!!

Fill out the Registration form below to join. Please have a parent or guardian fill this form out with you.

First Name: Last Name:
Address: City:
Zip: Home Phone:
Birth Date: Male or Female:
Grade: School:
Age: T-Shirt Size:
Mother's Name: Day Phone:
Father's Name: Day Phone:
Emergency Contact Name: Day Phone:
Medication/Allergies/Special Needs:   
Please write three (3) hobbies that you are interested in or like to participate in or you are currently participating this school year:
1.
2.
3.

In case of emergency, I understand every effort will be made to contact me. In the event I can not be reached, I hereby give my permission to the City of Orlando and CCSI/CITYTEENZ staff and volunteers to secure proper care of my child/dependent. It is understood that I, as a parent/legal guardian, will accept financial responsibility for payment of emergency transfer vehicle and all physician and hospital expenses.

I agree to indemnify, hold harmless and defend the City of Orlando and CCSI/CITYTEENZ staff and volunteers, officers, agents, servants and employee from any and all claims resulting from injuries, damages, losses or death sustained by me or my child and arising out of, connected with or in any associated with the activities of this program.

My child has my permission to be transported to the any and all PURPLE events by the City of Orlando and CCSI/CITYTEENZ staff and volunteers.

Parent's Name: Parent's Phone Number: