Club Kids for Peace - A Virtual After School Program

Juniors Club Kids for Peace - Grade 2-3

Weekly Tuesday Meetings: September 15, 2020 - January 19, 2021

Middles Club Kids for Peace - Grades 4-5

Weekly Wednesday Meetings: September 16, 2020 - January 20, 2021

Seniors Club Kids for Peace - Grades 6-8

Weekly Thursday Meetings: September 17, 2020 - January 21, 2021

Youth Participant's Info

Please provide the details for the participating youth below.
To register more than one child, please click the 'Register another youth participant' link.

Select the club session that corresponds with your child's age and the desired session time:

Participant's First Name

Participant's Last Name

Participant's Date of Birth:

Month

Day

Year

Grade:

Participant's T-Shirt Size

What do you hope your child get's out of the club?

Guardian's Info

Guardian's First Name

Guardian's Last Name

Relationship to Participant

Contact Phone Number

Shipping Address (to mail the supplies box)

First Name

Last Name

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country

Registration Fees

Registration Fee

$240 for youth in the USA or Canada$190 for youth outside of the USA and Canada (with no supplies or shirt)

The $240 registration fee includes a spot in our virtual after school program and a supplies box for one child. We will send a club supplies list to all youth outside of the USA and Canada. You may register more than one child by clicking the "Register Another Youth Participant' link above.

Please select the number of children you are registering:

Total Registration Fees:

Payment Information

Name on Card

Card Number

Code

Billing Email

Is your billing address different than your shipping address?

YesNo

Billing Address

First Name

Last Name

Address Line 1

Address Line 2

City

State/Province

Postal Code

Club Box, Prep & Supplies

Each participant will be mailed a club supplies box with many of the needed supplies prior to the club start date. For the club projects you will also need to have access to basic supplies such as: scissors, paper, markers, glue and recycled cardboard. You may save the cardboard box that your club supplies bag is shipped in.

Informed Consent, Liability & Media Release

I hereby give my approval for my child's participation in any and all activities prepared by Kids for Peace, Inc. during the Club Kids for Peace virtual after school program. In exchange for the acceptance of said child's/children's participation, I assume all risk and hazards incidental to the conduct of the activities, and release Kids for Peace, Inc. from any and all liability for injuries to said child/children arising out of participation in, or excusing themselves from selected club sessions. In case of injury to said child/children, I hereby waive all claims against Kids for Peace, Inc.- including all staff, camp directors and affiliates, all participants and sponsoring agencies engaged to conduct the event. I understand that the Zoom meetings will be implemented with the waiting room functionality for extra safety. I have read the latest Zoom Privacy Policy.

I hereby give permission for images of my child/children, captured during Club Kids for Peace through video and photo, to be used solely for the purposes of Kids for Peace, Inc. promotional materials and publications, and waive any rights of compensation or ownership thereto.

Parent's / Guardian's Signature*

Date

*By typing your name in the Signature field, you are indicating your acceptance of this agreement and your typed name and submission of this application to Kids for Peace will be treated as an original, written signature.

Contact Information