Kids Club Sign-Up!
Wild Rose Co-op's Kids Club welcomes kids ages 12 and under to join. By becoming a Kids Club member, you score a bunch of awesome advantages and free goodies!
First Child's Full Name
*
First Name
Last Name
First Child's Birthday
*
-
Month
-
Day
Year
Date
(optional) Second Child's Full Name
First Name
Last Name
(optional) Second Child's Birthday
-
Month
-
Day
Year
Date
(optional) Third Child's Full Name
First Name
Last Name
(optional) Third Child's Birthday
-
Month
-
Day
Year
Date
(optional) Fourth Child's Full Name
First Name
Last Name
(optional) Fourth Child's Birthday
-
Month
-
Day
Year
Date
Back
Next
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Signature
Clear
Submit
Should be Empty: