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Stepping Up

Stepping Up Registration

Stepping Up Registration

2023-2024 Stepping Up Registration Form
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
If child is currently not in school please put "n/a"
Club 21 Member?
Stepping Up Payment Options
Classes run from August through May
Monthly Payment Plan Agreement
If you are requesting funding from your Regional Center, please check box:

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

According to your spending plan
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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