Kids 4 Good Registration
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Parent/Guardian Name
*
First Name
Last Name
Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Household Size
*
Household Income
*
Less than $15,000
$15,001 - $25,000
$25,001 - $35,000
$35,001 - $50,000
$50,001 - $75,000
$75,001 - $100,000
Over $100,000
Child Information Section
*
Which Kids 4 Good Center you visiting?
*
Evansville, IN
Henderson, KY
Owensboro, KY
Madisonville, KY
Eldorado, IL
Chicago, IL
Chester, PA
San Antonio, TX
Terre, Haute, IN
Columbus, OH
Brooklyn, NY
Long Island, NY
Macon, GA
Atlanta, GA
Tampa Bay, FL
Cleveland, MS
Liberty, MS
New Orleans, LA
Charlotte, NC
Did you notice any emotional change in your child (confidence, joy, pride) after shopping?
*
Yes
No
How did your child feel after visiting Kids 4 Good?
*
Good
Bad
Do you feel your child walks away from Kids 4 Good feeling more valued or capable?
*
Yes
No
Have you seen a Positive Change in your Child?
*
Yes
No
Have you seen a shift in how your child views their own needs versus helping others?
*
Yes
No
How much financial relief does Kids 4 Good provide your family each week? (How much you save?)
*
Over $100
Over $200
Over $500
Has this mission of teaching Generosity helped with your child's mental health (If applicable)?
*
Yes
No
Parent Section: What does a place like Kids 4 Good mean to you in your community?
*
1. Photo & Video Release, I hereby grant 4 Good Community and its affiliates full permission to photograph, record, or video my child(ren) during participation at the Kids 4 Good Center. I understand that such photos, videos, and recordings may be used—without compensation—for marketing, promotional, educational, and public awareness purposes in print, online, or other media. I waive any right to inspect or approve the finished product or use. 2. Liability Waiver, I acknowledge that participation in Kids 4 Good programs is voluntary. I release and hold harmless 4 Good Community, its officers, directors, employees, volunteers, and partners from any and all liability, claims, demands, damages, or causes of action arising out of or related to any injury, illness, accident, or loss that may occur while my child(ren) or I are on the premises or participating in the program. 3. Goods Policy, I understand that all goods and resources received through the Kids 4 Good Center are provided free of charge as part of the program’s mission. I agree that these items may not be sold, exchanged for profit, or otherwise used for commercial purposes. 4. Consent & Acknowledgment, By signing below, I confirm that I have read, understood, and voluntarily agree to the terms of this waiver, release, and policy as a condition of entry into the Kids 4 Good Center.
*
Submit
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