Kids Rock Sign-Up Form

Parent Information

First Name

Last Name

First Name

Last Name

Phone Number

Email Address

Mailing Address

Child Information

First Name

Last Name

Birthdate

School Grade

Guardian

A guardian is approved to pick up your child from Kids Rock in the absence of their parents.

First Name

Last Name

To add additional children, click the "Add Another Person" button. If the parent information is the same for each additional child, you do not need to re-type the parent information.