Register Child's Name * First Name Last Name Date of Birth * MM DD YYYY Parent/Guardian Name * First Name Last Name Home Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/Guardian Cell Phone * (###) ### #### Parent/Guardian Alt Phone (###) ### #### Parent/Guardian Email * How did you hear about Pandoras Kids? * Internet News Paper Friend Other Name of Deceased Parent / Loved One * First Name Last Name Child’s relationship to deceased person * What type of activities would your child like to participate in? Let us know anything else that you would like us to know about your child and family. I FULLY UNDERSTAND PK TERMS, AND I REGISTER FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. * Thank you!
