New Participant Interest Form

Enter your information to register for Our Place Social Recreation Club events.

Fields marked with * are required.

Session Interest

Please select which Our Place Social Recreation Club Event(s) you are interested in. You must choose at least one.

No sessions are currently available to select.

Please select at least one session.

Identity

First Name *

0 / 60

Last Name *

0 / 60

Date of Birth *

Date of birth is required.

Email *

Phone Number *

Address

Address Line 1 *

Address Line 2

City *

State *

Postal Code *

Country *

Caregiver / Point of Contact

Name *

Email *

Phone number *

Relationship

Conservator

Are you conserved? *

YesNo

This field is required.

Funding & Personal Details

Are you a client of San Diego Regional Center? *

This field is required.

Do you plan to seek funding to cover the cost of this session? *

This field is required.

Are you an Arc Client? *

This field is required.

Are you enrolled in the Self Determination Program? *

This field is required.

Preferences & Interests

How did you hear about us? *

This field is required.

What are your interests and hobbies? (optional)

PickleballDatingRunningGolfArtMusicMixersClubsCampCookingOther

Safety & Additional Info

Emergency Contact Name *

Phone Number *

Email *

Relationship *

Allergies (optional)

Other information (optional)

Waiver & Participation Agreement *

Before participating in Our Place Social Recreation Club Sessions, you must complete and submit a signed waiver for each Session you are registered for. Please click the button(s) below to open the waiver(s) in a new tab, complete and submit each one. This page will automatically check if your waivers have been signed.

Please select a Session above to see waiver options.

Waiting for all required waivers to be signed...

Your information is kept confidential and shared only with those directly involved in coordinating your services.