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Club F.U.N. Registration

Club F.U.N.

Club F.U.N. Registration

2024-2025 Club F.U.N. Registration

Country
Address Line 1 *
City *
State/Province *
Postal Code *
DO YOU GIVE PERMISSION FOR CLUB 21 TO SHARE YOUR NAME, EMAIL, AND PHONE NUMBER WITH THE PROGRAM ROOM PARENT?
Room parents will be coordinating opportunities for connection outside of class meetings.
Month
/
Day
/
Year
What is Your Child's School Setting:
Previously done Club F.U.N.?
Payment Information
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:

According to your spending plan
Monthly Payment Plan Agreement
Payment Option
Credit Card Information
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
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