3rd Rock Kids, Inc.
Member Registration Form
1st Parent Name
First Name
Last Name
2nd Parent Name
First Name
Last Name
Child's Name
Child Date of Birth
Email
example@example.com
Mailing Address (for mailing enrollment packages - no P.O. boxes)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
T-shirt size
Youth XS size 5-6
Youth S size 6-7
Youth M size 8-10
Youth L size 12-14
Signature
My Products
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( X )
Enrollment Registration
$
165.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
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