Program Registration

Home Program Registration

Most classes fill up on registration day, so don’t delay in signing up. For more information including dates, times and program descriptions, please download a copy of our Community Program Guide.

It is now required that ALL program participants, including members, must complete a Program Registration Request Form below either online, in person at the front desk, or via postal mail.

Please complete the entire program registration request form. Completion of the form does not guarantee placement in the program. We will contact you at the phone number provided on the form to confirm your registration and to get your payment information. Please feel free to call us at (518) 867-8920 if you have any questions.

Please request only one course and one participant per submission. All fields are required.

Program Registration Request Form

Participant's Name:*
Gender:*
- Male
- Female
Date of Birth:*
Parent's Name:*
E-mail:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Daytime Phone:*
Evening Phone:*
Cell Phone:*
_________________________________________________
Emergency Contact:*
Relationship to Participant:*
Daytime Phone:*
Evening Phone:*
Cell Phone:*
_________________________________________________
Please explain any allergies, medical conditions or other needs of the participant which we should be aware of:*
Please list any medications the participant is currently taking of which we should be aware of:*
Medical Provider Name*
Medical Provider Phone Number*
_________________________________________________
Grade:*
School:*
_________________________________________________
Course Name:*
Session:*
Cost:*
Payment Options:*
- Check
- Credit Card
If paying by check, please make check payable to Ciccotti Center.

Mail to: Ciccotti Center Program Registration 30 Aviation Road Albany, NY 12205

If paying by credit card, please call (518) 867-8920 or visit the Ciccotti Center to process your secure registration. We accept MasterCard, Visa, American Express, Discover.

Please complete and return Participant Release of Liability below.
I confirm that I have read, understand, and agree to the Release of Liability Agreement*
- I Agree
View Release of Liability Agreement and Cancellation Policy
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