Please fill out the following information as completely as possible.
*Required Fields
EMERGENCY CONTACT
*Name:
*Relationship:
*Phone Number:
*Alternate Contact Person
*Phone Number:
FOR ON-GOING COMMUNICATION
Parent's Name:
Parent's Email:
*Student's First Name:
*Student's Last Name:
Student's Gender:
*Student's Birthdate:
Special Consideration:
(for example - dual diagnosis, food/plant allergies, negative reactions to men/women, etc)
Reading Level:
(best guess is fine)
registration
PAYMENT INFORMATION
THESE ARE NOT VENDORED CLASSES.
Discovery Days costs $40 per session.
Dance Classes cost $10 per session.
*Payment information:
Paying by cash:
Cash payments should NOT be mailed. After filling out this form, please bring cash to the Club 21 office at 539 N Lake Avenue, Pasadena, CA 91101
Paying by check:
After filling out and submitting this form please send a check (payable to Club 21)
Club 21 Attn: Registration
539 N Lake AvenuePasadena, CA 91101Paying by PayPal:
Please CLICK ON the option below that are most appropriate for you.
PLEASE NOTE
- Your family MUST be members of Club 21 for your child to participate in these classes.See our membership page for more information about joining Club 21.
- Your student/child is not considered registered for these classes until payment has been RECEIVED. You CAN NOT pay at the session.
- For Discovery Days parents/guardians are responsible for dropping students off at field trip locations and picking them up. Club 21 DOES NOT provide field trip transportation.
- All sessions of the Dance Class and Discovery Days are limited to 10 students. Registration is on a first come, first served basis.
For more information, please contact Jenni Perkins at jenni@clubtwentyone.org
some early chapter books
*Registering For:
