FS - Charles River Center Monthly Dance Registration Form

Charles River Center Monthly Dance Registration Form
October 2025 Dance

Halloween Party

October 10, 2025
Our Monthly Dances are for Individuals aged 16+.

They are held on Fridays from 6:30 p.m. - 8 p.m., meeting at
59 East Militia Heights Drive, Needham, MA 02492.

Everyone must be accompanied by a chaperone.

$10 per Individual
(Free for chaperones)

Please contact FamilySupport@CharlesRiverCenter.org with any questions.
Monthly Dance
Individual's Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Individual's Age*
Individual's Birthdate*

MonthDayYear
Date
Individual's Primary/Secondary Disability*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Contact Info (if different from Individual's)
Dance Chaperone's Name*

First NameLast Name
Should be Empty: