Girls Rock! RI Band Booster Fall 2019 Registration Form
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Hello future Band Booster participants (and parents/guardians)!

This registration form is for Band Booster with Girls Rock! Rhode Island. Please fill out this form to get your participant on board. Participants must be 11-21 years old. Cisgender boys may participate in Band Booster, but 50 percent of the members of each band must be girls, trans, or gender non-conforming youth.

Band Booster will be held weekly at our program space at 769 Westminster Street on the West Side of Providence. There are five time slots available, which are first-come, first-served. The Fall session of Band Booster will start September 16  and run weekly through mid December . We will follow the Providence Public School Calendar (no Band Booster on holidays or when school is canceled due to snow).

Band Booster is free, however you must fill out this registration form. Your weekly attendance is required to participate in order to achieve the goals you set with your band. It is important that you respect your bandmates by attending regularly. All members of the band must fill out the registration form.

Don't forget to click "submit" at the end of the form to complete the registration!

Girls Rock! RI
Participant Info!
Youth participant's first name *
Youth participant's last name *
Name participant prefers to be called by instructors
If different than above
What gender pronouns does the participant use? (optional)
i.e. she/her/hers, they/them/theirs, he/him/his, etc. We ask only so that we have a sense of how they would like us to refer to them.
Youth participant's email address *
Youth participant's phone number *
How do you prefer to communicate? *
Street Address *
Where you receive mail
Apartment/unit/floor #
City *
State *
Zip Code *
Age *
Participants must be 11-21 years old to attend Band Booster
Date of birth *
Grade *
School attending
What type of school is this?
Clear selection
Which of the available Band Booster time slots work with your schedule? Select all that apply!
Can you commit to attending Band Booster every week (barring sickness or major issues)? *
If you selected "no" or "maybe" above, please explain your hesitation to commit below:
Parent/Guardian or Primary Contact Info!
First name of primary contact/parent/guardian *
Last name of primary contact/parent/guardian *
Relationship to participant *
Primary contact's phone number(s)
Primary contact's email address *
We use email as our main mode of communication so please submit an email address that you check frequently
What is the best way to contact you? *
First name of secondary contact
In case of emergency only.
Last name of secondary contact
In case of emergency only.
Relationship of secondary contact to participant
Secondary contact's phone number(s)
Secondary contact's email address
What is the relationship of the secondary contact to the primary contact?
More About You!
To be filled out by the youth participant
What goals do you hope to achieve as a result of attending Band Booster? What do you hope to do or learn? *
Have you participated in other programs at Girls Rock! Rhode Island? *
If you have participated in other Girls Rock! RI programs, which ones have you participated in? *
If we offered other programs, what else would you like to learn/do/talk about?
How did you hear about Girls Rock! RI's Band Booster program?
More About You/Your Child!
Demographics, medical issues, etc. (If under 18, to be completed by a parent/guardian)
Racial/ethnic identity (optional)
Creating a group of participants that reflects the diversity of Rhode Island is a priority for our programming. In addition, some of our funders require the racial/ethnic and economic make-up of our program population to be documented. Providing the following information will help us meet our diversity goals and help us continue to receive funding for future sessions. Check any that apply.
Language needs
Band Booster is conducted in English. If your child's primary language is other than English we will do our best to find interpretation assistance, but cannot guarantee availability. If you/your child would like interpretation assistance during Band Booster, please indicate their preferred language here:
Medical conditions/allergies/dietary restrictions
Do you/your child have any medical conditions, allergies, dietary restrictions, or other issues that the staff should know about? All medical information will be kept confidential and shared only with necessary staff.
Behavioral/emotional/social issues
Do you/your child have any behavioral, emotional, or social issues the staff should know about? We ask so that we can best serve our participants and have adequate staff on hand if special attention is needed. Again, all personal information will be kept confidential and shared only with necessary staff.
Who else will be in your band?
Please list their name(s) and contact info below (your band members will also need to complete this form):
Almost Done! Click "SUBMIT" below!
To complete your registration: Make sure to click SUBMIT on this form!

We will send you a confirmation email to let you know that we've received your registration form.

Questions? Visit or contact Rikki Davis, Program & Operations Coordinator, at or 401-443-2869
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