Youth Registration

Contact us at 267-768-7738 or Email us at Info@kidzindahoodinc.com
We are excited for you to be apart of our community!
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Youth Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Nationality
Parent/Caregiver Name *
Email *
Grade *
School *
Youth Phone *
Parent Phone *
Address *
Emergency Contact *
Do you require transportation? *
Required
Dietary restrictions/Allergies *
Activities/Events you would like your youth to participate in: *
I understand that pictures may be taken during events/activities within the program and can be used for media purposes (brochures, social media, etc) *
Required
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