Girls Rock! RI Youth Programs Spring 2017 Registration Form
Hello future rockers (and parents/guardians)!

This registration form is for YOUTH to sign up for spring workshops and classes with Girls Rock! Rhode Island. Please fill out this form to get your rocker on board. Participants must be 11-18 years old or 14-18 years old (depending on the specific workshop/class - see below). We welcome girls, women, trans, and gender non-conforming individuals in our programming.

All classes and workshops are first-come, first served registration and will be held at our program space at 769 Westminster Street on the West Side of Providence. Need-based financial aid is available.

SPRING SCHEDULE AND TUITION FEES:

Workshops:
Songwriting Intensive with Laila Aukee (for youth 14+ and adults): Saturdays April 22, April 29, and May 6 from 11am-2pm (3 session series) /// $150
Performance & Stage Presence with Courtney Swain (for youth 14+ and adults): Saturday April 8th from 11am-2pm (onetime) /// $55
Intro to DJing with Rachel Sholly (for youth 14+ and adults): Sunday April 23rd from 1pm-3pm (onetime) /// $40

Classes:
Intro to Music Theory with Reba Mitchell (for youth 14+ and adults): Wednesdays April 5, 12, 26, May 3, 10, 17 from 6:00-7:00pm (6 weeks) /// $150
Band Class with Karen Orsi (for youth 11-18): Thursdays April 6, 13, 27, May 4, 11, 18 from 4:15-5:45pm (6 weeks) /// $175

More info and class descriptions here: http://girlsrockri.org/register-grouplessons/

Don't forget to click "submit" at the end of the form to complete the registration! We will follow up with you about payment and financial aid requests.

Thanks!
Girls Rock! RI

Participant Info!
To be filled out by parent/guardian
Youth participant's first name
Your answer
Youth participant's last name
Your answer
Name you want to be called by instructors
If different than above
Your answer
Youth participant's email address
Your answer
Youth participant's phone number
Your answer
Street Address
Where you receive mail
Your answer
Apartment/unit/floor #
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Age
Participants must be 11-18 years old to attend Youth Programs
Your answer
Date of birth
MM
/
DD
/
YYYY
Grade
School attending
Your answer
What type of school is this?
Parent/Guardian Contact Info!
First name of primary contact/parent/guardian
Your answer
Last name of primary contact/parent/guardian
Your answer
Relationship to participant
Your answer
Primary contact's phone number(s)
Cell
Your answer
Home
Your answer
Work
Your answer
Primary contact's email address
We use email as our main mode of communication so please submit an email address that you check frequently
Your answer
What is the best way to contact you?
First name of secondary contact
In case of emergency only.
Your answer
Last name of secondary contact
In case of emergency only.
Your answer
Relationship of secondary contact to participant
Your answer
Secondary contact's phone number(s)
Cell
Your answer
Home
Your answer
Work
Your answer
Secondary contact's email address
Your answer
What is the relationship of the secondary contact to the primary contact?
Your answer
Pick Your Workshop/Class!
Which workshop/class would your child like to attend?
(If they want to take more than one workshop/class, please fill out a separate form for each)
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