The Dare to Care Kids Club
CALL US AT 310-692-0853 or 310-266-5831
Dare to Care Kids Club - 2025 Application
First Name
Age
Last Name
Home phone
Zip code
State
Grade
City
School
Address
Mother's Name
Cell Phone
Emergency Contact 1
Work phone
Email
Cell phone
Father/Guardian's Name
Address
City
State
Zip code
Home phone
Cell phone
Work phone
Email
Emergency Contact 2
Cell Phone
Physician's Name
Phone
Medical Card No.
Permission to administer medicine?
Additional Children?? Add their information here.
First Name
First Name
Last Name
Last Name
Age
Age
School
School
Grade
Grade
Grade
