Cheer and Dance Registration Form

Cheer and Dance Registration

Program Ages 4-50
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
PARTICIPANT'S NAME

First NameLast Name
BIRTH DATE

MonthDayYear
Sport Program (Select all that apply)
IS PARTICIPANT A REGIONAL CENTER CLIENT?
ARE YOUR SERVICES THROUGH SELF-DETERMINATION, REGIONAL CENTER OR OTHER?
REGIONAL CENTER UCI#
CSC WORKER NAME

First NameLast Name
CSC WORKER'S PHONE NUMBER
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
Should be Empty:

Cheer and Dance Registration