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Serving the youth of our communities through education, preservation, and recreation

We would like to thank the Port of Los Angeles for their continued support.
 
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CLASSES
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PLEASE NOTE: THERE IS A KNOWN PROBLEM WITH THE WAY FIREFOX HANDLES THIS REGISTRATION PAGE.
PLEASE USE INTERNET EXPLORER OR SAFARI TO COMPLETE CLASS REGISTRATIONS!

 

Cub Scout Belt Loop Class Registration

All fields are required.

Cub Scout Name:               
Street Address:    
City:                    State:  Zip Code:
Phone (with area code):     
Email address:   
Pack Number:     Council:

Select one class per period

1 to 1:45
1:45 to 2:30
2:30 to 3:15
3:15 to 4

Guardian/Emergency Information
Parent/Guardian Name:       
Home Phone with Area Code:                      
Work/Cell Phone with Area Code:    
 

Emergency Contact Name:    Relationship:
Home Phone with Area Code:                      
Work/Cell Phone with Area Code:    

Does the participant have a history of or currently have any physical limitations that might prevent him/her from fully participating in any classes?  Yes  No
If yes, please describe below.  If none, state "NONE"

Please list any special medications, allergies to food or drugs or any other pertinent medical information.  If none, state "NONE"


 

 
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Copyright © 2008-2009 Cabrillo Beach Youth Waterfront Sports Center
Last modified: Sunday, September 12, 2010 12:18 PM