PBG Academy Registration Form - LAUSD Region North
Pretty Brown Girl is dedicated to empowering Black and Brown girls. You are receiving this form because your student has an opportunity to participate in Pretty Brown Girl Academy at LAUSD Region North. Sessions will be held once a week on Tuesdays or Thursdays from 4pm-5pm PST for 3rd-5th grade girls. If you have any questions completing the form, please contact LaTonya Reese at lwalton@prettybrowngirl.com.
Student Name
*
First Name
Last Name
Student Grade Level
*
Please Select
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Student Email (if applicable)
Student Home Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
What school does student currently attend?
*
Please Select
Academy for Enriched Sciences Magnet
Alta California
Anatola Ave
Andasol Ave
Apperson
Arminta St
Balboa G/HG/HA Mag
Bassett St
Beachy
Beckford Charter
Bellingham
Bertrand Ave
Blythe St
Brainard
Broadous
Broadous Magnet
Burton
Calabash Charter Academy
Calahan St
Calvert Charter
Camellia
Canoga Park
Cantara St
Canterbury
Canterbury Magnet
Capistrano
Cardenas
Carlson Hospital
Carpenter Community
Castlebay Lane
Chandler Learning Academy
Chase
Chatsworth Park Urban Planning Magnet
Cohasset St
Coldwater Canyon
Colfax
Columbus
Coughlin
Danube Ave
Darby Ave
Dearborn Charter
Dixie Canyon
Dyer
El Dorado
Emelita St.
Enadia Way
Encino Charter
Erwin
Fair Ave
Fernangeles
Fullbright Ave
Garden Grove
Gault St
Germain Academy
Gledhill St
Glenwood
Granada
Gridley
Haddon
Hamlin Charter
Harding
Hart St
Haskell STEAM Magnet
Haynes Charter
Hazeltine
Herrick
Hesby Oaks Leadership Charter
Hubbard
Justice St Academy
Kester
Kittridge
Knollwood Prep Academy
Korenstein
Lake Balboa College Prep
Lanai Rd
Landgon Ave
Lankershim
Lassen
Lemay St
Liggett St
Limerick Ave
Lockhurst Dr Charter
Lokrantz SpEd Center
Lorne St
Lowman SpEd Center
Mayall St Academy Magnet
Melvin Ave
Monlux
Mosk
Napa St
Nestle Ave Charter
Nevada Ave
Newcastle Ave Charter
Noble
Obama
Osceola
Oxnard
Panorama City
Parks Learning Center
Parthenia Academy Charter
Pinewood Ave
Plainview Academic
Plummer
Pomelo Community Charter
Porter Ranch Community School
Ranchito
Reseda
Rio Vista
Riverside Dr.
Roscoe
San Fernando
San Jose St
Santana Arts Academy
Saticoy
Sendak
Serrania Ave Charter
Sharp
Sherman Oaks
Shirley Ave
SOCES Magnet
Stagg St
Stonehurst
Strathern
Sunland
Sunny Brae Ave
Superior St
Sylmar
Sylmar Leadership Academy
Sylvan Park
Tarzana
Telfair Ave
Toluca Lake
Topeka Dr Charter
Tulsa St
Valerio
Van Gogh Charter
Van Nuys
Vanalden Ave
Vena
Victory
Vinedale
Vintage Magnet
Vista Del Valle
Welby Way Charter
Wilbur Charter
Winnetka Ave
Woodlake
Woodland Hills Charter
Please select the name of the school.
Please select which session works best for your student to attend weekly.
*
Please Select
Session 1: Tuesdays from 4pm-5pm PST
Session 2: Thursdays from 4pm-5pm PST
T-Shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Extra Small
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Adult 1XL
Adult 2XL
Adult 3XL
Please note that one complimentary T-Shirt will be provided for the student. All PBG T-Shirts come in unisex sizes with a looser fit. Please review the sizing chart below to ensure the correct size is selected before submitting this form. Exchanges will not be permitted.
Parent/ Guardian Name
*
Parent/ Guardian Email
*
Parent/ Guardian Phone
*
Relationship To Student
*
Please Select
Mother
Father
Stepparent
Grandparent
Aunt
Uncle
Other
If other, please share
Did you review the sizing chart before selecting the Student's T-Shirt size?
Yes
No
Do we have your consent for the student to participate in PBG Academy?
Yes
No
Do you agree to our Terms and Conditions?
*
Submit
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