Skip to Main Content

Loading

Loading

Create a Website Account - Manage notification subscriptions, save form progress and more.

Website Sign In

How Do I...?
Services
City Government
Resources

Search

Home
Form Center

Form Center

Search Forms:

Search Forms Select a Category

All Categories
Alarm Permit Forms
City Clerk Forms
Emergency Preparedness

Employment Application
Environmental Sustainability Forms
Grant Applications
Management Forms

Parks and Rec Forms
PW Forms
Registration Forms

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

2023-2024 Afterschool Program Participant Form

Sign in to Save Progress

This form has been modified since it was saved. Please review all fields before submitting.

Steps

1. Parent and Participant Information This section is complete This section is incomplete
2. Individuals authorized to pick up my child/children from City of Malibu Programs other than Parent/Guardian This section is complete This section is incomplete
3. Medical Information This section is complete This section is incomplete
4. Signature This section is complete This section is incomplete

Parent and Participant Information

Participant First Name*
Participant Last Name*
Sibling(s) Name
Afterschool Program (s)*
What school does your child attend?
Grade Level:*
Parent/Guardian First Name*
Parent/Guardian Last Name*
Is your child a BGCM member?*
Primary Phone Number*
Alternate Phone Number
Primary Email*
Alternate Email
Continue

Individuals authorized to pick up my child/children from City of Malibu Programs other than Parent/Guardian

Name
Phone Number
Relationship to Particpant
Name
Phone Number
Relationship to Participant
Name
Phone Number
Relationship to Participant
Continue |Go Back

Medical Information

Family Physician
Phone Number
Insurance and Policy Number
Allergies (If None, type NA)*
Medications (If None, type NA)*
Medical Conditions (If None, type NA)*
Other Helpful Information
Continue |Go Back

Signature

Printed Parent/Guardian Name*
Digital Signature*
Date*
Date
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
Submit | Go Back

* indicates a required field

Connect With Us

Youtube

Instagram

Contact Us

23825 Stuart Ranch Road
Malibu, California 90265-4861

Phone Number: 310-456-2489
Fax: 310-456-3356

Facebook
Twitter
Pinterest
Delicious
Blogger
LinkedIn

Home
My Account
Printer Friendly
Email Page
Contact Us
Hear This Page
RSS
Site Map
Translate Page
Notifications
Documents
Help

Helpful Links

GIS
Contact Us
Hotlines

/QuickLinks.aspx

FAQs

Am I required to get a permit for a party at my home?
Do I need a business license to do business in Malibu?
Is the Malibu Pier open?
Can I apply for a U.S. passport at City Hall?
My neighbor is remodeling, how early may he begin work?
I am moving to Malibu - who do I call to hook up utilities?

/FAQ.aspx

Using This Site

Home
Site Map
Contact Us
Accessibility
Copyright Notices
Privacy Policy

/QuickLinks.aspx

Government Websites by CivicPlus®

E-Notifications

Report a Problem

[]