Kids Club Membership Form

1
Please select your nearest town* This field is required.
Carstairs
Drumheller
Didsbury
Eagle Hill
Hanna
Olds
2
Name* This field is required.Child #1
3
Birthday* This field is required.
Birthday
Year
Month
Day
4
Mailing Address* This field is required.
Please select
Please select
Alberta
Province
5
Parent/Guardian Name* This field is required.
6
Email* This field is required.
example@example.com
7
Phone Number* This field is required.
Area Code
Phone Number
8
Terms & Conditions* This field is required.The Co-op respects your privacy and will administer the personal information that you provide to it by way of this Kid’s Club Application in accordance with its privacy policies and related practices. The personal information that you provide to the Co-op is being collected and may be used for one or more of the following purposes: Email & Address may be used to send birthday cards and other communications related to Kid’s Club activities. Phone number may be used for general contact purposes related to this application or related to Kid’s Club activities. Birthdate will be used to confirm eligibility for Kid’s Club and may be used to send birthday cards. I consent for the use of my child’s personal information to join Co-op’s Kid’s Club and for my child to participate in Co-op Kid’s Club activities.
By clicking the submit button, I agree to terms & conditions.
9
Parent/Guardian Signature* This field is required.
Clear
10
Do you want to register another child?* This field is required.
YESNO
11
Name* This field is required.Child #2
12
Birthday* This field is required.
Birthday
Year
Month
Day
13
Do you want to register another child?* This field is required.
YESNO
14
Name* This field is required.Child #3
15
Birthday* This field is required.
Birthday
Year
Month
Day
Should be Empty: