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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Enrollment Registration
$
165.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Choose from one of the PayPal options to
make your payment.
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