BHReg New Online Account Request

Welcome to BHReg!  In order to register online for Community Services classes, you must have an account. Please fill in the required fields and submit this form when completed. (*) Denotes a required fields for submission of this form.

Please be advised: All new account holders residing in Beverly Hills must submit proof of residency in order to register for classes.

Account holder (Parent or legal guardian, if under 18 years)
*First Name: *Last Name:
*Home Street Address:


*City:

*State:
*Zip Code:
*Phone Number:
Alternate Phone Number:
*Email Address:

*Birthdate: (Month/Day/Year)

*Gender: Male Female

Other family members at this address

Family Member 2:
First Name:
Last Name:
Birthdate: (Month/Day/Year)
Gender: Male Female
Grade Level in School:

Family Member 3:
First Name:
Last Name:
Birthdate: (Month/Day/Year)
Gender: Male Female
Grade Level in School:

Family Member 4:
First Name:
Last Name:
Birthdate: (Month/Day/Year)
Gender: Male Female
Grade Level in School:

Family Member 5:
First Name:
Last Name:
Birthdate: (Month/Day/Year)
Gender: Male Female
Grade Level in School:

Family Member 6:
First Name:
Last Name:
Birthdate: (Month/Day/Year)
Gender: Male Female
Grade Level in School:

Family Member 7:
First Name:
Last Name:
Birthdate: (Month/Day/Year)
Gender: Male Female
Grade Level in School: