Youth Registration for a Dress

Please Select If You Are a Group Home or Organiation Registering 5 or More Recipients
I am registering multiple youth for a group home or organization for girls
- I am registering multiple youth for a group home or organization for girls
Name of Organization*
Contact Name at Organization*
First Last
Phone
Email*
Number of Spaces You Need to Reserve*
Preferred Time*
Please Complete this Section if You Are Registering Yourself or an Individual
Youth's Name*
First Last
Email to Receive Confirmation*
Phone (for Youth)*
Date of Birth*
Name of DCFS Child Social Worker
First Last
Preferred Time*

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To report child abuse, neglect or abandonment contact the Los Angeles County Child Protection Hotline at 1-800-540-4000

Please Select If You Are a Group Home or Organiation Registering 5 or More Recipients