Kidz-into-Action-Registration-2023

KIDZ INTO ACTION 2023 REGISTRATION

Membership is currently for 2 years from day of enrollment
Child or Adult 1*

First NameLast Name
Date of Birth:*

MonthDayYear
Child or Adult 2

First NameMiddle NameLast Name
Date of Birth:

MonthDayYear
Child or Adult 3

First NameMiddle NameLast Name
Date of Birth:

MonthDayYear
Child/Children's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent, Guardian and/or Caregiver Information
Full Name *

First NameMiddle NameLast Name
Mobile Phone Number*

Area CodePhone Number
Home Phone Number*

Area CodePhone Number
E-mail*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Relation to the child:*
Yearly Membership

Is for 2 years
No refunds are available, only program credits will be granted should
medical or other extenuating circumstances dictate.
Program(s) of Interest
Type a question

My Products

1 CHILD or ADULT$95.00

2 CHILDREN or ADULTS$165.00

3 CHILDREN or ADULTS$240.00

Total $0.00

KIDZ INTO ACTION 2023 REGISTRATION