Cheer and Dance Registration Form

UDID Registration

After pre-registration please contact your CSC or FMS worker to request approval of services for this program immediately. Once authorization is approved, we will contact you to confirm and finalize registration, including distributions of uniforms.

UDID Registro

Después de la preinscripción, por favor contacta a tu trabajador de CSC o FMS para solicitar la aprobación de los servicios para este programa de inmediato. Una vez que se apruebe la autorización, nos pondremos en contacto contigo para confirmar y finalizar la inscripción, incluyendo la entrega de uniformes.
PARTICIPANT'S NAME

First Name/NombreLast Name/Apellido
BIRTH DATE/FECHA DE NACIMIENTO

MonthDayYear
Sport Program (Select all that apply)
IS PARTICIPANT A REGIONAL CENTER CLIENT? ¿EL PARTICIPANTE ES CLIENTE DE EL CENTRO REGIONAL?
ARE YOUR SERVICES THROUGH SELF-DETERMINATION, REGIONAL CENTER OR OTHER? ¿SON TUS SERVICIOS A TRAVÉS DE AUTODETERMINACIÓN, CENTRO REGIONAL U OTRO?
REGIONAL CENTER UCI# / CENTRO REGIONAL UCI#
CSC WORKER NAME / NOMBRE DEL TRABAJADOR CSC

First NameLast Name
CSC WORKER'S PHONE NUMBER / NUMERO DE TELEFONO DEL TRABAJADOR CSC
Please enter a valid phone number.Format: (000) 000-0000.
CSC WORKE'S EMAIL
example@example.com
DOES YOUR PARTICIPANT REQUIRE A 1 ON 1?
IS THERE ANY OTHER INFORMATION WE NEED TO KNOW ABOUT YOUR PARTICIPANT?
PARENT/GUARDIANS NAME

First NameLast Name
PARENT/GUARDIANS PHONE NUMBER
Please enter a valid phone number.Format: (000) 000-0000.
PARENT/GUARDIANS EMAIL
example@example.com
PARENT/GUARDIANS ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cheer and Dance Registration

Program Ages 4-50
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