2020 Kids in Action Summer Class Registration
Please fill out this form below to register your child for a summer class. Call (281)358-9446 if you have any questions. We look forward to spending the summer with you!
Childs Name *
Your answer
Childs date of birth *
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Second child's name
Your answer
Second child's date of birth
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Third child's name
Your answer
Third child's date of birth *
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YYYY
Parents Name *
Your answer
Parents Name
Your answer
Phone Number *
Your answer
Cell Phone Provider *
Second phone number *
Your answer
Email Address *
Your answer
Home Address (Address, City, State, Zip) *
Your answer
Special accommodations/ Special needs or allergies (reply NONE if N/A) *
Your answer
Alternate contact (Name, phone number) *
Your answer
I give permission for my child's image to be used for advertising reasons on Facebook, website, etc. *
How did you hear about Kids In Action? *
Class Information: Which class will you be attending? *
Required
Day of the Week *
Required
Time *
Your answer
Start Date
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Payment Option: Visa/Mastercard, CC #, Expiration Date, Security Code (can also pay via check/cash in person)
Your answer
I agree to periodic text messaging, alerts, closures, etc. *
Required
I understand there are no make-ups or refunds in the summer. (Type name) *
Your answer
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