CivicPlus Sample Site

Registration Form

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Participant Information

Participant Name*

D.O.B*

Gender*

Male

Female

School*

Grade*

Parent / Guardian Name*

D.O.B.*

Address*

City*

State*

Zip*

Phone*

Civic City Resident*

Yes

If no, what city/town?

Emergency Contact Information

Contact Name*

Address*

City*

State*

Zip*

Phone*

Medical Information

Any medical conditions/disabilities?*

Yes

If so, please explain condition.

Dance Classes

Youth Classes

	Cheer Camp
	Little Tot Playgym
	Little Tumblers

	Rhythmic & Movement
	Tiny Munchkins

Adult Classes

	Ballet
	Ballroom
	Belly Dance
	Bollywood
	Brazilian
	Creative
	Dance & Fitness

	Hawaiian Hula & Tahitian
	Hip-Hop
	Jazz
	Modern
	Salsa
	Tap

Sports Classes & Leagues

Badminton Classes

	Introduction Level Zero
	Level One
	Level One (B)

	Level Two
	Level Two (B)
	Level Three

Sports Leagues

	Basketball
	Soccer

	Softball
	T-Ball

Sports Camps

Camps

	All-Day Multi Sports Camp
	Half-Day Multi Sports Camp
	Badminton
	Baseball
	Basketball
	Football
	Golf
	Ice Skating
	Indoor Sports Jam

	Martial Arts
	Multi-Sports Extravaganza
	Rock Climbing
	Soccer
	Softball
	Tennis
	Volleyball
	Wheels Safari

* indicates required fields.

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