IPAD Kids Club Membership Form

Please select your nearest town*
Name

First NameLast Name
Birthday*

YearMonthDay
Birthday
Address

Street Address

Street Address Line 2

CityProvince

Postal
Parent/Guardian Name

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Do you want to register another child?

YesNo
Name (child #2)

First NameLast Name
Birthday

MonthDayYear
Date
Terms and Conditions

The Co-op respects your privacy and will administer the personal information that you provide to it by way of this Kid’s Club Application in accordance with its privacy policies and related practices. The personal information that you provide to the Co-op is being collected and may be used for one or more of the following purposes:Email & Address may be used to send birthday cards and other communications related to Kid’s Club activities. Phone number may be used for general contact purposes related to this application or related to Kid’s Club activities. Birthdate will be used to confirm eligibility for Kid’s Club and may be used to send birthday cards.

I consent for the use of my child’s personal information to join Co-op’s Kid’s Club and for my child to participate in Co-op Kid’s Club activities.
Terms & Conditions*

By clicking the submit button, I agree to terms & conditions.
Parent/Guardian Signature*

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