CleanAIR Kids Club Registration
Please have your parent or guardian fill out the form. Information is confidential and only used by 88.3 The Wind.
Membership kit shipping is currently on hold due to t-shirt availability.
Child's First Name
Your answer
Child's Last Name
Your answer
Child's Birthday (Child must be 12 or under)
MM
/
DD
/
YYYY
Parent/Guardian First Name
Your answer
Parent/Guardian Last Name
Your answer
Parent/Guardian Phone Number
Your answer
Parent's Email Address
Your answer
Mailing Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Child's Shirt Size (2T-YXL) (Please specify if Adult size is needed.)
Your answer
Please read the CleanAir Kids Club Media Release Terms: Any production, performance or event recorded or used from CleanAir Kids Club (hereby known as the “program”) may be used by 88.3 The Wind for on air, online and any other station sponsored activity or promotion. In exchange for the opportunity (but not the guarantee) to participate or appear in the above-identified Program, I hereby irrevocably grant and assign to KWND 88.3 The Wind the right to use my child’s “Likeness” (i.e. name, biography, physical likeness and/or voice), in any media in connection with or for the promotion of this Program and/or 88.3 The Wind. This grant and assignment includes, but not limited to, the right of 88.3 The Wind to capture, record, use, reproduce, exhibit, edit, project, display, copyright, publish, release, sell and resell my child’s Likeness (in whole or in part) through photographic images, moving pictures, videotaped images, sound recordings and any other types of media, from and after today’s date, for any lawful program, production or use authorized by 88.3 The Wind, including but not limited to educational, programming, publicity and promotional purposes. I agree that 88.3 The Wind may use my child’s Likeness for any period of time that 88.3 The Wind, in its sole discretion, finds reasonably necessary; and that I shall not receive any compensation for my participation in the above-identified Program or for 88.3 The Wind’s use of my child’s Likeness.I confirm that all materials I may furnish for this Program are either my own or that I or my child am authorized to use them and that 88.3 The Wind has no obligation to me or to any third party in connection with the use of such materials. I agree that my child’s participation in the Program confers upon me no rights to the use or ownership of or copyright interest in my child’s Likeness as captured or used by or for 88.3 The Wind in connection with the Program. I release 88.3 The Wind, its employees, agents and assigns from all liability that may arise from any claims by me and/or any third parties in connection with my child’s participation in the Program or use of my child’s Likeness. I understand that 88.3 The Wind has no obligation to broadcast or use the above-identified Program.
Do you prefer to pick up your membership packet at the station, or would you like it mailed to your home?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms