Enroll in Glowin' Within Thank you for choosing to participate in the Glowin’ Within workshop! We are thrilled for you to join this extraordinary experience! First Name Last Name Upload your favorite picture of you! Cell Phone Number Email Address Your Parent/Guardian's Name Your Parent/Guardian's Email Address Your Birthday What school do you go to? Shirt Size X-Small Small Medium Large X-Large Which category describes you? Please select all that apply. American Indian or Alaska Native Asian Black or African American Hispanic, Latino, or Spanish Origin Middle Eastern or North African Native Hawaiian or Other Pacific Islander White Multiethnic Prefer not to disclose Who referred you to Glowin' Within? Why do you want to attend Glowin' Within? On a scale of 1-10, rate your level of self-confidence in regards to your physical appearance / body image. 1 - I am very insecure in my physical appearance. 2 3 4 5 6 7 8 9 10 - I am very confident in my physical appearance. On a scale of 1-10, rate your level of confidence in regards to your character (who you are as a person.) 1 - I am not proud of the person I am. 2 3 4 5 6 7 8 9 10 - I am very proud of the person that I am. On a scale of 1-10, rate the relationship you have with your closest friends. 1 - I don't feel good about my friendships. 2 3 4 5 6 7 8 9 10 - I feel great about my friendships. On a scale of 1-10, rate the relationship you have with your family. 1 - I feel disconnected from my family. 2 3 4 5 6 7 8 9 10 - I feel very connected to my family. On a scale of 1-10, rate how physically active you are. 1 - I am not physically active at all. 2 3 4 5 6 7 8 9 10 - I am very physically active. What do you think are your 3 biggest strengths? What do you think is your greatest area of improvement? Who do you look up to the most and why? How do you think your friends and family would describe you? What are you most proud of in your life? What have you struggled the most with in your life? If you have food allergies, please list them below. If you could recommend a friend, who would it be and why? If there is anything specific you would like us to know about you, please share below. What are your favorite healthy snacks and meals? What song INSPIRES you the most What's your favorite DANCE song? What is your favorite quote? What topics are you most eager to explore and learn about in life?? Submit View this profile on Instagram Youth Fit2Lead (@y0uthfit2lead) • Instagram photos and videos
