KC Teen Membership Application

KC Teen Membership Application

KC Society programs are free of charge or very low cost. Yearly membership is a $25. Scholarships are available. First come first served. We ask each member to volunteer and participate in all fundraisers to keep our clubs and programs free or low cost.

A Little About YOU!
Name*

First NameLast Name
Date of Birth

MonthDayYear
Phone Number

Area CodePhone Number
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age as of TODAY's Date*
We contact you, our teens the best way possible so everyone could always be involved with all KC Society events, programs, and opportuntinities and never be left out. Teens are not required to acquire or previously own any social media account. If you do, you can like our page on Facebook or Follow us on Instagram

Parental Information!
Our goal is to serve you and bring out the best of WHO you are. We do that by giving you something that allows you to enjoy the time.
Parents/Guardian Name
Parents Cell Phone

Area CodePhone Number
I hereby voluntarily elect to allow my child, to participate in all of KC Society Programs, Events, Fundraisers, and Volunteer activities . I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, that may be sustained by my child Attendance at these events.

IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute the Release For full, adequate, and complete consideration fully intending to be bound by same.
Parents E-signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Should be Empty: