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 Avenue
Pasadena, CA 91101
Paying 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.