NBC Kids Club Registration
Childs Name #1
*
First Name
Last Name
Age
*
Date
*
-
Day
-
Month
Year
Date
Childs Name #2 (optional)
First Name
Last Name
Age
Date
-
Day
-
Month
Year
Date
Childs Name #3 (optional)
First Name
Last Name
Age
Date
-
Day
-
Month
Year
Date
Childs Name #4 (optional)
First Name
Last Name
Age
Date
-
Day
-
Month
Year
Date
Name of Parent or Guardian
*
First Name
Last Name
Paren/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Zipcode
*
Submit
Should be Empty: