Program Registration

Please use the form below to register for event programs online. You may use this form to register for multiple programs.

Please contact our Family Support Director - Renee McCorkle at rmccorkle@soshoresupport.org with any questions.

Registrant Information

Name(Required)

First Last

Nickname

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Parent's Email(Required)

Parent/Guardian with legal custody to be contacted in case of illness or injury :

Name

First Last

Relationship to the Individual

Home Phone

Cell Phone

Work Phone

Program Information

Program Name(s) You Are Registering For:(Required)

If you are registering for more than one program, please indicate each program here:

Session Dates You Are Registering For:(Required)

Program Cost

Please enter the total number of session dates you are registering for here (for example, if you are registering for 4 Drum Alive sessions and 4 Group Fitness Classes put the number 8 here):

Price: $10.00

Total

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

You will not be registered until full payment is received. For payment plan information, please contact the Director of Family Support. REFUNDS/CANCELLATIONS: You must notify the Director of Family Support at least two (2) days in advance of your cancellation in order to receive a refund. Refunds will not be granted for missed classes or planned absences nor will refunds be granted for special events requiring advance purchase of tickets unless a replacement is found. Credit or refunds will be granted if the Family Support Center changes the location, time, or date of the program which prohibits your attendance or if the Family Support Center cancels the program due to insufficient registration. All participants will be notified at least two (2) days prior to the start of a program if there has been a cancellation, except in cases of inclement weather. Program schedules, fees, and/or instructors are subject to change. Occasionally, there may be an error in the day, time, fees or location on a flyer, our Facebook page, or South Shore Support Services’ website. If so, we will do everything possible to correct the situation promptly! Thank you for your patience and understanding should these situations arise.

Program Registration

Registrant Information

Program Information

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