Survey - Food Bank of the Rockies' Kids Club Sign Up

Please fill out the information below to join the club. We collect your email to send you exciting club member only news and events. We collect your address to send cool prizes when you cash in your coins!

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

Make sure the box is checked so you don't miss out on any exciting news from the club!

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Question - Required - Child's First Name

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Question - Required - Child's Last Name

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Question - Required - I am a

boy

girl

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Question - Required - Please share your birthday with us.

Month

Day

Year

Question - Not Required - What's the name of your school?

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Question - Required - By checking this box, I or my parent or guardian, if I am under age 13, give Food Bank of the Rockies permission to use the information I submit for the Kung Food Fighters Kids Club. Food Bank of the Rockies will not share or sell my information, but may contact me on behalf of the club.

I am 13 or older and I agree to share my information.

I am the parent or guardian of the aforementioned child and agree to share his/her information.

Question - Not Required - Name of Parent or Guardian giving permission if child is under 13.