2019-2020 SSSOD Dance Year Registration Form- Cranston, East Side/Mount Hope and Kent County.
Please use this form to register for the 2019-2020 dance year with at one of the Greater Providence YMCA's, Shooting Stars School of Dance locations.
Email address *
Child's First Name *
Your answer
Child's Middle Name *
Your answer
Child's Last Name *
Your answer
Date Of Birth *
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Age *
Your answer
Gender *
Grade Entering in Fall 2019 *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Primary Parent/Guardian Contact Name (First and Last) *
Your answer
Primary Parent/Guardian Date of Birth *
MM
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DD
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YYYY
Primary Parent/Guardian Address *
Your answer
Primary Parent/Guardian Phone Number. Please include area code and if it is your cell, work or home number. *
Your answer
Primary Parent/Guardian Contact Email (we suggest something that is not @aol.com as it has been brought to our attention that addresses with this domain are not always received due to security blocks from AOL) *
Your answer
Primary Parent/Guardian Additional Phone Number(s). Please include area code and if it is your cell, work or home number. *
Your answer
Secondary Parent/Guardian Name (First and Last) *
Your answer
Secondary Parent/Guardian Date of Birth *
MM
/
DD
/
YYYY
Secondary Parent/Guardian Address
Your answer
Secondary Parent/Guardian Phone Number. Please include area code and if it is your cell, work or home number.
Your answer
Secondary Parent/Guardian Email
Your answer
Secondary Parent/Guardian Additional Phone Number(s). Please include area code and if it is your cell, work or home number.
Your answer
#1 Emergency Contact/ Authorized Pick-up *
Your answer
#2 Emergency Contact/ Authorized Pick-up *
Your answer
#3 Emergency Contact/ Authorized Pick-up *
Your answer
2019-2020 Enrollment Agreement (Please Check All) *
Required
I clearly understand all of the policies and procedures listed above and in the handbook for the 2019-2020 dance year. *
Name of person filling out this form *
Your answer
Does your child have any allergies? *
Your answer
Does your child take any medications? *
Your answer
Are there any special instructions that we should be aware of (disability, unauthorized pick-ups, special learning requirements, etc.) *
Your answer
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