Club Connections

Club Connections 2021-2022 Registration

Club Connections High School is now FULL. If your student is in high school, please fill out this waitlist form

Club Connections Beyond (anyone beyond high school) has limited spaces still available. 

Would you like to be contacted in addition to your parents?
If yes, please provide your email and phone number below
Special Diet:
If "other" please indicate what that is:

Answering the questions below,  will help our Club Connections Team create lessons that can meet a diverse group of needs.

Any difficulty with sight or hearing?
If yes, please indicate what those are:
Does Club 21 have permission to release photos of your teen:
by clicking "yes" you give your consent
Club Connections Payment Options
If you are requesting funding from your Regional Center, please check this box:

If you are using Self Determination funds, please fill out this information:

Payment Option
Credit Card Information
Visa MasterCard American Express Discover

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Make this a monthly payment?
Make this a monthly payment?
Your total payment will be
Your credit balance will cover
Your credit card will be charged
Your bank account will be charged