KIDZPluz+ Inc.        Membership for Kids & Adults!

Name ___________________________

Social Security #__________________

Address___________________________

City___________________State________

Phone________________Cell___________

Parental consent for your child to be photograph, interviewed, or video during events or for group pictures.

• YES________ No________

• Food Allergies?___________What type?

        _______________________________________

• Application for adult__________ or child______________

Area of interest you would like to volunteer?

List skills/qualifications:

• Times or days available:

Sign_________________________________Date________________

Print & Mail to KidzPluz+ Inc. Box 315  Osceola AR. 72370

Membership fee is $25.00 annually. Make checks payable to Kidz+