Registration

Registration

*Must be at least 12 years of age *(A $15 deposit is required of all appointments, which will be refunded after your service is complete) Kamp 4 Kids Youth Center Event Address: 707 Neshaminy Mall, Bensalem PA 19020 Contact us at 215-876-7802 (Call or Text)
Full Name

First NameLast Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
What city do you reside in?
Gender
Age
Ethnicity
Will you be bringing any children along who'll need childcare while you get your hair done? If so, please comment their name(s), age(s), and if they have any type of disability or require extra help.
What service are you looking to get done? (Multiple choice)
Cuts For A Cause is an organization who's only mission is to provide free hair and beauty services to parents who have a child with special needs, disability, or illness. As well as providing services to individuals who have experienced devastating hardships such as, serious illnesses, disabilities, homelessness or tragic financial downfalls, etc... Please tell us your story as to what makes you eligible for this service.
Please select a date that works best for you. We are open every other Sunday 11:30am-5:30pm. (Multiple choice)
Is your phone number mentioned above a good way to reach you to schedule your appointment? (If not please provide an alternate phone number below) If so, we will reach out within 24-48 hours to put you in our schedule. We can't wait to meet you and give you a day of much needed care and relaxation!
How did you hear about us?
I give permission to Cuts For A Cause and Kamp 4 Kids to use any photos or videos taken of myself or my children(if applicable) to be used for web-based publications/social media, print advertisements, or anything else. I consent to receiving the services chosen above and release all Cuts For A Cause volunteers of any and all liability, damage, and/or expenses arising out of or in connection with actions, claims, and/or damages resulting in personal injuries and disabilities (physical and/or psychological), transmission of a communicable disease, or anything other that I might incur as a result of the service provided today and I agree to voluntarily participate understanding these risks and their outcomes.
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