New Submission

Program Selection*field type checkbox
Program SelectionJune 12, 2023 - June 16, 2023June 26, 2023 - June 30, 2023
Last Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
First Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Age*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Date of Birth*field type date
Gender*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Student's Academic School*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Student Grade Level*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Address 1*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Address 2field type single line
Input blocked. Maximum character limit of 4000 characters reached.
CIty*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
State*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Zip*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Parent / Guardian Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Guardian Relationship To Participant*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Home Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Work Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Cell Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

Contact In Case Of Emergency

Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Relationship To Student*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Home Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Work Phonefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Cell Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Physician's Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Physician's Phone*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

Dance Background

Current Studio / Dance Schoolfield type single line
Input blocked. Maximum character limit of 4000 characters reached.

Which Dance Style Have You Studied? Please Indicate How Many Years Of Each

Balletfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Modernfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Jazzfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Tapfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Africanfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Hip Hopfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Lyricalfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Otherfield type single line
Input blocked. Maximum character limit of 4000 characters reached.

Sports

What sports do you play?field type checkbox
What sports do you play?BasketballFootballGolfOther

Clothing Sizes

Children's T-Shirtfield type radio button
Children's T-ShirtSML
Adult Sizes T-Shirtfield type radio button
Adult Sizes T-ShirtSMLXLXXLXXXL
WAIVER FOR PROMOTIONAL PHOTOS & INJURY INCURRED DURING THE SAND HILLS COMMUNITY CENTER SUMMER YOUTH PROGRAM
I HEREBY GIVE PERMISSION TO EPPDMI TO USE ANY PHOTO THAT INCLUDES MY CHILD FOR PROMOTIONAL PURPOSES.
Permission To Use Photos*field type radio button
Permission To Use PhotosYesNo
I WILL NOT HOLD EPPDMI OR ITS STAFF (PAID OR VOLUNTEER) RESPONSIBLE FOR ANY INJURIES SUSTAINED TO MY CHILD WHILE PARTICIPATING IN THE WORKSHOP.
IF I AM NOT AVAILABLE IN THE EVENT MY CHILD NEEDS MEDICAL ATTENTION, I HEREBY GIVE PERMISSION TO THE STAFF OF EPPDMI, OR ANY COMPETENT MEDICAL AUTHORITY, TO RENDER ANY NECESSARY MEDICAL ATTENTION TO MY CHILD.
Child's Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Print Name Of Adult Or Parent / Legal Guardian*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Signature Name Of Adult Or Parent / Legal Guardian*field type signature
Date*field type date
Date will be captured on form submission

Sand Hills Community Center 2023 Summer Youth Program

Contact In Case Of Emergency

Dance Background

Which Dance Style Have You Studied? Please Indicate How Many Years Of Each

Sports

Clothing Sizes