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Funky Divas & Dudes
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First Name
Last Name
Email Address
Password *
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Parent 1 Name *Please put your name here & the CHILD'S name in the above area FIRST NAME & LAST NAME. This way it is your child's name that shows up on our rosters.
Cell Phone
Parent 2 Name
Home Phone
Date of Birth
List CDC Room #, REC, (For Afterschool Enrichment only) or write N/A
Postal/Zip Code
Emergency Contact (& Relationship)
Emergency Contact Phone #
List any allergies, medications, health concerns, or previous injuries
I give permission for my child to go in to the water at Santa Monica beach. (CAMP QUESTION ONLY. ALL OTHERS FILL IN N/A)
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