California Sports Center Online Registration

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact (Name and Phone Number) other than parent*

Health Insurance Carrier and Policy #*

Coupon Code

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from California Sports Center. Standard message and data rates apply. Reply STOP to opt out

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name*

Last Name*

Type*

How can we contact you?

Home Phone

Work #

Cell # * Receive Text Message Notifications. By opting in, you agree to receive SMS messages from California Sports Center. Standard message and data rates apply. Reply STOP to opt out

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

CSC Notes

T-shirt size

CAMB only-Casa di Mir p/u? Rm?

CAMB only-Casa di Mir dropoff?

Every child means the world to us. We look forward to welcoming you into the family!

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

CSC Notes

T-shirt size

CAMB only-Casa di Mir p/u? Rm?

CAMB only-Casa di Mir dropoff?

Every child means the world to us. We look forward to welcoming you into the family!

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

CSC Notes

T-shirt size

CAMB only-Casa di Mir p/u? Rm?

CAMB only-Casa di Mir dropoff?

Every child means the world to us. We look forward to welcoming you into the family!

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

CSC Notes

T-shirt size

CAMB only-Casa di Mir p/u? Rm?

CAMB only-Casa di Mir dropoff?

Every child means the world to us. We look forward to welcoming you into the family!

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

CSC Notes

T-shirt size

CAMB only-Casa di Mir p/u? Rm?

CAMB only-Casa di Mir dropoff?

Every child means the world to us. We look forward to welcoming you into the family!

Enroll in Classes

Select Class *

Add Another Student

Required Policies

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Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

Additional Info

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Student #5 (Show-Hide Details)

Additional Info

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Questions or Concerns

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Required Policies

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