Registration Form

Registration Form
Kidz Klub is where play meets purpose and faith meets fun!

For more information about Kidz Klub please visit https://oasisofhollywood.org/kidz-klub/

We provide free pickups at Grant Elementary from 2:20-2:45, at the Harold Way entrance!

We provide free dropoffs within the Hollywood area!
Date/Time: Wednesday's, 3:00-5:00PM
Address: 4150 Monroe St. LA, CA 90029

Any further questions or concerns?
Please contact Oasis directly at (323) 469-3027 or by emailing kidzklub@oasisofhollywood.org
Parent / Guardian Email
example@example.com
Child's Name

First NameLast Name
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Grade
Child's School
How will your child be getting to Kidz Klub?
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does Your Child Have Any Allergies
Parent / Guardian Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Consent and Release from Liability:

I’ve given permission to my child to attend Kidz Klub. I understand that my child can either get picked up for Kidz Klub at Grant Elementary, or dropped off by a parent/guardian. I understand that Kidz Klub will provide drop offs in the Hollywood area only. In case of emergency, I hereby authorize Kidz Klub to contact emergency personnel and release pertinent information. I also agree to release Kidz Klub and its personnel, agents, and volunteers from any liability resulting from and/or in connection to this after school activity.
Signature
Emergency Contact
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relation to Child
Is there anything else we need to know or be aware of?
Should be Empty:

Registration Form

Emergency Contact