Kid Champion Child Waitlist Application

Kid Champion Child Waitlist Application
Child's Full Name*

First NameLast Name
Child's Nickname
Child's Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Any additional comments or questions?
Should be Empty: